Mail tuition to:  Danny Kaspar			       Payment:  Amount:  _______________
	            P. O. Box 633013				           Check #:  _______________
	            Nacogdoches, TX  75963-3013
						        CAMP SELECTION – Check one
T-Shirt Size (circle one)

A)  Youth Sizes:    M      L 

B)  Adult Sizes:    S      M     L   XL     XXL
                                                  A)  June 20-24 Camp
                                                   1) Resident ($330) ___________
                                                   2)  Non-Resident ($265)   ______
                                                   3)  Day Camp ($190)   __________
							
                                                   B)  August 9-13 Camp
                                                   1)   Morning Camp ($105)   _______
                                                   2)   Afternoon Camp ($105)   ______
                                                   3)   Day Camp ($190)   __________

Note: Read camp information for applicable late fee charges.


Name _________________________________ Age ________    Date of Birth: _____/_______/_______    	 


Address ___________________________  City __________________ State _______    Zip____________


Home Phone   (     )             Parent’s Work Phone (     )             Cell (     )		 

E-mail  address ________________________________        Grade (Fall 2010)  __________________

I (parent) _____________________________ agree that (participant) _______________________ may  participate in The Danny Kaspar Basketball Camp at Stephen F. Austin State University.  In consideration of participant in this event, I agree, on behalf of the above named child, his/her heirs and representative to fully and forever release, and hold harmless The Danny Kaspar Basketball Camp, its agents, servants, and employees from any and all claims, demands, right of action of causes of action, present or future, whether the same be known, anticipated or unanticipated, resulting from or arising out of participation in this event.  I HEREBY AUTHORIZE IN ADVANCE ANY NECESSARY MEDICAL TREATMENT REQUIRED BY THE ABOVE NAMED CHILD WHILE IN ATTENDANCE OF THIS CAMP.  I ALSO ACKNOWLEDGE THAT I HAVE/WILL NOTIFY THE CAMP PERSONNEL OF ANY SPECIAL MEDICAL NEEDS OR INFORMATION REQUIRED BY THE ABOVE NAMED CHILD.  Also, I understand that all rules and regulations for the camp/event will be enforced and any violation by my child could result in a call to me with possible request to pick up my child with no refunds being given.  This camp is owned and operated by Danny Kaspar.

Signature of Parent or Guardian _____________________________________  Date_______________________


Emergency Contact Number___________________________ Health Insurance Policy_______________________


Name:___________________________________________ Policy Number____________________________________

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