COACH RUDD'S BASKETBALL CAMP

REGISTRATION FORM 2025

Complete a form for each child, if more than one.

CAMP WEEKS: Circle your week/weeks

Camper Name: __________________________________________ Age: _______ Grade: _______ (grade your camper will be in as of September 1, 2025) Parent Name: __________________________________________ Address: _______________________________________________ City: _______________________ State: _______ Zip: __________ Phone Number: _________________________________________ Email Address: __________________________________________

WEEK 1: June 23 - June 26 WEEK 2: June 30 - July 3 WEEK 3: July 7 - July 10 WEEK 4: July 14 - July 17 WEEK 5: July 21 - July 24 Cost: $140/wk per camper Camp Time: 9:00am - 3:00pm

MEDICAL CONSENT/WAIVER OF LIABILITY

*ALL CAMPERS MUST HAVE PRIMARY ACCIDENT INSURANCE*

Insurance Company Name: ____________________________________________

Health History (Check all that apply)

c Allergies c Diabetes c Penicillin c Asthma c Hay Fever c Seizures

c Other: ______________________________________________________________ Medications: _______________________________________________________________________

Emergency Contact (Full Name): ______________________________________________________ Phone: _______________________________ Relationship to Camper: ____________________

CAMP RELEASE:

In consideration of making facilities and/or services available, I do hereby for and on behalf of myself and my heirs, and legal representatives, release and forever discharge all Glen Burnie High School and/or any of its staff from any and all claims and demands of every kind, nature and character which I, or my child, may have or hereafter acquire for any and all damages or losses which may be suffered or sustained by me, or my child, in connection with our activity and all such claims are hereby waived and released.

c Participants may be photographed at some time during camp. I allow my campers photograph to be used for Coach Rudd's Basketball Camp purposes.

Parent Signature: _____________________________________________ Date: _______________

REGISTRATION: Please mail or email a completed registration form to Coach Rudd

PAYMENT: ALL payments must be submitted through Online School Payment (OSP)

Use the QR code above