Basketball Camps International

Potato Valley Basketball Camps July 6 - 10, 2009
Name:
Street:
City: Province/State: Country:
Home Phone: Postal/Zip Code: Male:
Work Phone: Cell Phone: Female:
Age at Camp: In Case of Emergency Contact:
Date: Emergency Phone #:

To Register: Send a $25.00 cheque  to BCI, c/o Iain Dunlop by June 20, 2009

After June 20, 2009 the cost is $ 50.00 Family Rates Available

Waiver: I hereby give my consent and approval to the publication of the applicant in the program conducted by Basketball Camps International (BCI) from any and all liability for any injuries and/or illness while at camp. Proof of medical coverage must be produced on day of registration.
Parent/Guardian Signature:
Medical Insurance Card #:

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Mail to: Iain Dunlop 4616 Juniper Road, Bristol, New Brunswick E7L 2K1