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APPLICATION CAMP SESSIONS I
(PLEASE CHECK) JUNE 21-25 INDIVIDUAL CAMP OVERNIGHT CAMPER COST $260 SUNDAY 1-3 P.M. CHECK-IN; THURSDAY 2-4 P.M. CHECKOUT DAY CAMPER COST $195 UNE 26-27 JUNIOR HOG-FATHER SON CAMP FRIDAY 4-5 P.M. CHECK-IN; SATURDAY 5:30 P.M. CHECKOUT GOING INTO GRADES 1-6 ____.JULY 5-8 POSITION CAMP SUNDAY 2-4 P.M. CHECK-IN; WEDNESDAY 10:00 A.M. CHECKOUT ---JULY 8-11 POSITION CAMP WEDNESDAY 2-4 P.M. CHECK-IN; SATURDAY 10:00 A.M. CHECKOUT JULY 12-16 INDIVIDUAL CAMP SUNDAY 1-3 P.M. CHECK-IN, THURSDAY 2-4 PM. CHECK-OUT JULY 19-23 INDIVIDUAL CAMP SUNDAY 1-3 P.M. CHECK-IN; THURSDAY 2-4 P.M. CHECK-OUT -OVERNIGHT FATHER & CAMPER COST $ 150* -,"AA,*PER FATHER & SON - DAY FATHER & CAMPER COST $I 00* - OVERNIGHT CAMPER COST $225 DAY CAMPER COST $170 OVERNIGHT CAMPER COST $225 DAY CAMPER COST $170 OVERNIGHT CAMPER COST $260 DAY CAMPER COST $195 OVERNIGHT CAMPER COST $260 DAY CAMPER COST $195 APPLICANT Information NAME GRADE ADDRESS CITY STATE ZIP PARENT/GUARDIAN PHONE ROOMMATES IF YOU ARE AN OVERNIGHT CAMPER, PLEASE INDICATE THE NAMES OF THE CAMPERS YOU WOULD LIKE TO ROOM WITH OR NEARBY WHILE AT THE BASKETBALL CAMP ALL CAMP SESSIONS ARE FOR BOYS AGES 8- 18 NOTE: NO REFUNDS FOR CANCELLATIONS WILL BE MADE UNLESS WE ARE NOTIFIED IN WRITING 2 WEEKS IN ADVANCE OF THE CAMP (LESS THE $50 ADMINISTRATIVE FEE). MASTERCARD VISA EXP. DATE $5.00 credit card processing fee. CHECK ONE 0$100 DEPOSIT OR FULL PAYMENT MAKE CHECKS OUT TO: NOLAN RICHARDSON RAZORBACK BASKETBALL CAMP IF YOU HAVE ADDITIONAL QUESTIONS CONTACT THE NOLAN RICHARDSON RAZORBACK BASKETBALL CAMP CALL 501-575-6388/FAX 501-575- 6525 officers, agents, employees, representatives, successors and assign of and from all rights and claims for damages, injury, or loss to person or property which may be sustained during participation in camp activities or while at camp, whether or not damages, injury or loss are due to negligence. It shall be understood that participating campers are contracting with the employee and not the University of Arkansas, and that the University and the State of Arkansas do not assume any contractual obligations for the conduct of the employee's activity. Campers will not be allowed to play unless the information is submiffed and the form signed by the parent or guardian of the camper. PARENT/ GUARDIAN: RETURN TO: I/We, the undersigned, hereby certify that I (we) am (are) the parent or legal guardian of the camper. I hereby give permission 1 for the staff of the camp to seek during the period of the camp appropriate medical attention for the camper and for the medical attention to be given and for the camper to receive medical atten- in the event of accident, injury, or illness. I will be responsible for any and all costs of the medical attention and treatment, except for that covered by the camp's excess medical coverage policy. I/We, the undersigned, for ourselves, our heirs, executors and administrators, waive, release, and forever discharge the University of Arkansas at Fayetteville, and the camp, and its staff, Parent or Guardian signature MAIL COMPLETE APPLICATION ALONG WITH THE APPROPRIATE FEES TO: NOLAN RICHARDSON RAZORBACK BASKETBALL CAMP BOX 748 FARMINGTON, AR 72730-0748 (Feel free to make copies for friends) DOCTORS STATEMENT OF SCHOOL OR check in I have examined and found him healthy and able to compete in basketball and general recreational activities (of his choosing) during the Nolan Richardson Basketball Camp. List any allergies to medications Pertinent information ( diabetic, epileptic, previous fractures, ect... ate xamined Physician signature Last Tetanus Shot |