Kelsi Musick - WBB- Fundamental Day Camp Coach Musick & Coach Evans 2019 BASKETBALL FUNDAMENTAL DAY CAMPS Grades: K - 6th grade 9am - 12pm (Boys & Girls) Dates Offered: June 24-26 or July 22-24 Site: SWOSU Wellness Center Cost: $115.00/camper For more information contact Kelsi Musick or Cophie Anderson kelsi.musick@swosu.edu or cophie.anderson@swosu.edu 580/302-3926 or 816/308-8055 Name:_____________________ Address:_________________________________ City ________________________________ Zip________________ Home Phone:________________ Emergency Phone:_____________________ Email address:____________________________________________ Age:______Grade (just completed):________School:_________________________ CAMP SESSION (circle date) : (June 24-26) (July 22-24) T-SHIRT SIZE (circle one) : Youth: S M L Adult: S M L XL Liability/Insurance Statement I hereby authorize the staff of Kelsi Musick Basketball Camp to act for me according to their best judgment in any emergency requiring medical attention and I waive and release the camp from any/all liability for injuries incurred while at camp. _______________________________________________________________________________________ Parent/Legal Guardian Signature Date Please list all previous health conditions the Camp staff needs to be aware of (i.e. asthma, concussions, allergies, injuries,etc.)____________________________________________________________________ Insurance Company________________________________ Policy #________________________________ Please return this portion along with payment to: Kelsi Musick - WBB- Fundamental Day Camp 100 Campus Dr. Weatherford, OK 73096