Name: Age (as of June 2011): Grade (1-12):
T-Shirt Size: XL L M S Youth L Youth M Youth S Gender Male Female
Height: Weight
Camper email
Parent email (if none, type none@coachlane.net)
Home Address
City State Zip
Parent's Name: Parent's Home Phone Parent's Work Phone
Emergency Contact Number
Please choose from the following sessions
Session 1: July 5-8 / Basketball Day Camp Morning (ages 6-13)—9 a.m. to noon / $95 Afternoon (ages 7-13)—1 to 4 p.m. / $95 All Day (ages 7-13)—9 a.m. to 4 p.m. / $195 *includes lunch
Session 2: July 18-20 / Boys Shooting and Offensive Skills
Morning (ages 8-15) 9 am to noon / $80 Afternoon (ages 8-15) 1 to 4 pm / $80 All Day (ages 8-15) 9 am to 4 pm / $170 *includes lunch
I hereby authorize the directors of the Lane Basketball Camps to act or me according to their best judgment in any emergency requiring medical attention and I hereby waive and release the camp from any and all liability for injuries incurred while at camp yes no {Name of Parent or Guardian}