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REGISTRATION FORM Name ______ School______ Grade in Fall 1998 Age on 6/1/98 ____ T-shirt size_______ Address_________ city State Phone Contact Phone Zip IN CASE OF EMERGENCY Camp session: (check one) _______ -June 21-25, 1999 _________June 26-27, 1999 _________June 28-29, 1999
I understand that neither Cleveland State University, the Rollie Massimino Basketball Camp, nor anyone connected with the camp is responsible for accidents, or for medical, dental or other expenses incurred as a result of instruction given to the camper by the staff. The camp reserves the right to send any camper to a hospital for diagnosis or treatment. The parents or guardian will assume all responsibility. PARENT/GUARDIAN SIGNATURE DATE |