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APPLICATION FORM: 2008 SCHUYLER WARRIORS BASKETBALL CAMP

Name__________________________________________ Grade next Fall_______

Home phone____________________ Work phone____________________

Address___________________________________City______________________ Zip__________

T-Shirt Size (circle one):

This is the application for enrollment of ______________________________ in the Schuyler Warrior Basketball Camp on June 2-5, 2008. I grant permission to the camp director, assistants, or assigned chaperones of the camp to act on my behalf for said minor in granting permission for evaluation/treatment of minor medical problems. I understand that should a major medical problem arise, an attempt will be made to notify me by telephone. In the event that I cannot be reached, I hereby, give my consent to such medical treatment as deemed necessary by a licensed physician. In addition, I understand that Schuyler Central High School and the camp director do not provide camp medical insurance. I hereby release Schuyler Central High School, all its employees, and camp staff from all claims on account of any injuries which may be sustained by my son while attending the Schuyler Warrior Basketball Camp. I also agree to indemnify Schuyler Central High School, all its employees, and camp staff for any claim which may hereafter be presented to my minor son as a result of any such injuries. This camp admits all qualified applicants without regard to disability, race, color, religion, national or ethnic origin, or sexual orientation.

Accident & Medical Insurance Co._______________________________________

Policy # _______________________

Parent/Guardian Signature_______________________________Date_______________________

____$35 If registered on or before Friday, May 16th, 2008

____$40 If registered after Friday, May 16th, 2008

Please Select One:

____A green/white customized water bottle with the SCHS Warrior logo (no additional cost)

or

____Official size and weight outdoor basketball with SCHS Warrior logo (no additional cost)

Make checks payable to: Jeff Droge

Mail to: Jeff Droge - P.O. Box 382 - Schuyler, NE 68661