TOM YESTER'S MOHIGAN BASKETBALL CAMP 2008

June 11, 12, 13, 14; 9:00-12:00
At Morgantown High Gyms
for Boys Grades 3rd-9th ( as of next year 2008-09)
Sign up on www.mohiganbasketball.com
Or e-mail coachhoffman@mohiganbasketball.com

Please fill out release form and mail it with a check
Made out to MYBO

Release Form
I hereby authorize the directors of the Morgantown High basketball camp to act according to their best judgment in an emergency requiring medical attention. I hereby release the coaching staff, trainers, and Morgantown High of liability. I know of no mental or physical problems which may affect my child's ability to safely participate in the camp. I will be responsible for any medical or other charges in connection with his attendance at the Morgantown High Basketball Camp.

Child name: __________________________________

_____________________________________________
Insurance company:

_____________________________________________
Policy Number:

_____________________________________________
Parent or guardian Signature:

In case of an emergency, Please call :

_____________________________________________
Name:                                Relationship:

_____________________________________________
Phone #1                           Phone#2

Size T-Shirt (adult sizes) ________________

School to be attended next year: _________________________

Grade as of next year: _____________

Size T-Shirt (adult sizes) ________________

Cost: Camp special

$55.00 before April 25th / $65.00 if mailed after April 25

Mail check with this form made out to:
MYBO
109 Apolla Dr.
Morgantown, WV 26501