Player’s Name_____________________________________________

Height_________ Age________ Next Year Grade (2008-2009)____________

Home Address___________________________________________

City_____________________ State_______ Zip_________________

Home Phone (_____)______________________________________

Roommate Preference_______________________________________

Please indicate your payment plan:
☐  $100.00 deposit - Check Enclosed
☐  $185.00 (Total Tuition) - Check Enclosed
Note: Deposit is non-refundable
Make all checks payable to: Blue Chip Basketball Camp and mail application and deposit to: Blue Chip Basketball Camp - P.O. Box 155- Sheperdsville, KY 40165. Call (502) 543-7308 for further information.

RELEASE & WAVIER: The “Blue-Chip” Post Camp does not provide medical insurance for campers. This is the responsibility of the parent or guardian. Your signature below gives permission for the treatment for injury or illness at the Georgetown Community Hospital with the understanding that the financial responsibilty is yours.

Parent Signature____________________________________

Date_______________

Shooting Camp