Lu Dog Basketball Camp Registration Form

2017

For CHECK payment ONLY, type in your information, print out the form, and have a parent SIGN IT. Change your printer settings to print in landscape.

Name:

Age:  

 Grade: 

Phone: 

Address:

 City:

State:

Zip:

Email: ** required for confirmation

 

School:

Date of Birth:

 
Team with my friend:

Emergency Contact:

Emergeny Phone:

T-Shirt Size: Adult S M L XL XXL Child L

I hereby authorize the staff of the Lu Dog Basketball Camp to act for me according to their best judgment in any emergency requiring medical attention for any injury or illness incurred while at the camp. I have no knowledge of physical impairment that would be affected by the above named camper's participation in the camp program as outlined in the brochure. I also understand that the camp retains the right to use for publicity and advertising purposes photographs of campers taken at camp.

 Cost: $230.00 ($100 deposit)

For More Information Call:
(805) 338-1633
Parent or Guardian (please print full name)______________________________ Signature:____________________________

July 31 - Aug. 4, 2017 August 7-11, 2017    

Mail To:
Lu Dog Basketball Camps
62 Maegan Pl. #4

Thousand Oaks, CA. 91362

Make checks payable to:
LuDog Basketball Camps