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David Adelman

CAMP APPLICATION

(Parents, please complete both sides)

 

Name___________________________________________

Address_________________________________________

City, State, Zip___________________,_______,__________

Age____Height_________ Weight__________

School ______________________________ Entering Grade___

Please note any medical conditions or allergies to medications.

___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________

 Name of parent or guardian : ___________________________

Emergency phone #__________________________________

Signature of parent please complete next page
_________________________________________________
Send completed form along with your $50 deposit

(made out to Hoops Education Basketball Camp) to:

David Adelman

161 E. Chicago Avenue

#55C

Chicago, IL 60611

 

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