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REGISTRATION FORM

Campers Name:________________________________________________________________Date of Birth:_________________

Address:________________________________________________City:______________________Zip:_____________________

Parents/Guardian Names:_________________________________ Phone#:_______________

Entering Grade: (Circle one) 4th 5th 6th 7th 8th

Campers T-shirt Size: (Circle one) Youth: Small Medium Large Adult: Small Medium Large

Indemnity Waiver and Parent Consent Form

I hereby request that you accept this registration form for the Wampus Cat Basketball Camp during the dates set forth in the application. I hereby release Conway Public Schools and all of its employee’s from any claims on account of injuries that may be sustained by the participant while attending this Camp. Each participant should have his/her own medical insurance.

___________________________________________________________________________ Date:______________________________

Signature of Parent/ Guardian

Make Checks payable to:

Conway Athletic Booster Club

Please mail or return registration form and payment to the Athletic office in Buzz Bolding Arena.

Athletic Office

Attn: Coach Will Johnson

2300 Prince St. Conway, AR 72034

Camp Information

The camp will be run by the Conway Wampus Cat Basketball coaches and players.

Each camper will receive a T-shirt.

Prizes will be awarded to winners of contests.

Participants will be drilled on basic fundamentals, participate in live scrimmages, obstacle course, hot shot, knock out, etc.

Please direct any questions to 450-6631 or email Coach Will Johnson

June 15,16,17 @ Buzz Bolding Arena

Session 1: 4:00-6:00 pm entering grades 4-6

Session 2: 6:15-8:15 pm entering grades 7-8

The Cost is $40 a camper.

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