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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