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Sign up for Kirksville boys basketball camp

When: May 26th-May 29th

Where: PRIMARY GYM

Camp Staff will be Coaching Staff/Former Players (Alumni)

TIMES:

8:00 - 9:30 AM (boys entering) GRADES 4th -6th $40.00

10:00 - 11:30 AM (boys entering) GRADES 7th-8th $40.00

12:30-2:30 (boys entering) GRADES 9th-12th $40.00

â?¢ *CAMP IS OPEN TO ALL PLAYERS, NOT JUST KIDS FROM KIRKSVILLE. HOWEVER, IF YOU ARE GOING TO BE AT the 9th-12th Camp YOU MUST ATTEND (Plan To Attend) KIRKSVILLE SR. HIGH in 2015-16.

â?¢ Pay with Cash or Check: PLEASE MAKE CHECKS PAYABLE TO TIGER BASKETBALL(Memo Boys Basketball Camp) Drop off @ HS OFFICE OR MAIL TO : Tyler Martin 1202 East Jefferson KIRKSVILLE, MO 63501

â?¢ Forms need to be turned in by May 11th to be guaranteed a T-Shirt

** CAMPER INFORMATION**

NAME: _________________________ GRADE FOR 2015-16: __________

AGE: _____ BIRTHDATE: __________

ADDRESS: _____________________ CITY: _________________ ZIP: _______

HOME PHONE #: __________________ EMERGENCY #: _____________________

SHIRT/SHORT SIZE (circle): Youth: 10-12 14-16 Adult: S M L XL XXL

(When in doubt on sizes, order a size too big as we do not order extra shirts!)

**Identification and Medical Treatment Authorization**

The undersigned parents and/or guardians of (campers name) ____________________, the applicant, for and in further consideration of the basketball camp acceptation said applicant, does hereby release and discharge Kirksville R-III Schools and it's representatives, employees, and agents from any and all debts, claims, demands, actions, damages, caused of action, judgments, or suits of any kind which may arise or be occasioned as a result of any course of instruction or the applicants participation in the basketball camp. In addition, I/we being the parents and/or guardians of the applicant authorize the Kirksville R-III and its agent's permission to request emergency medical treatment or care as necessary to insure the well being of our dependent. Further, I claim the registrant has had a physical examination in the past year and was found fit for all physical endeavors.

Signature of Parent or Guardian: _________________________ Date: ____________________

Family Health Insurance Provider: ____________________________________________________

Family Health Insurance Policy #: _____________________________________________________

**Camper Code of Conduct Contract**

As a participant in the Kirksville Tiger Basketball Camp, I agree to comply with all of the rules, regulations, and directives of the coaching staff, and I will treat all of the coaching staff and other camp participants with respect, courtesy, and good will. I have read the above statement and understand that failure to comply with that statement may result in my removal from the camp without refund.

Participants Signature: _________________________ Date: _______________________

For additional information contact Tyler Martin by email at tmartin@kirksville.k12.mo.us

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