Boys Basketball Camp form.

KELLER INDIAN

BASKETBALL CAMPS

Camp Director:           Randall Durant       Head Boys Basketball Coach- Keller High School

CAMP DATES:     JUNE 11^th-14^9h, 2012

AT KELLER HIGH SCHOOL:

Session I:    Incoming K- 4^th graders                  9:00-12:00

Session II:  Incoming 8^th-9th graders                2:00-5:00

AT INDIAN SPRINGS MS:

Session III: Incoming 5^th-7^th graders                 9:00-12:00

Cost for each session is $90. before June 1^st and  $95 after June 1^st. Make checks payable to Keller High School

Name: ____________________________________________ Grade (next year): _____

Address:_______________________________________________________________

Phone #:______________________________ Emergency Phone #:______________

Email__________________________________________________________________

Session(s) Attending (circle one):      Session I         Session II          Session III              

T-shirt Size (circle one):         Adult Sm                             OR                          Youth Sm

                                                                Adult Med                                                           Youth Med

                                                                Adult Lg                                                               Youth Lg

                                                                Adult XL

I acknowledge that _______________________________ is physically able to participate and I hereby authorize the camp directors to act for me according to their best judgment in any emergency requiring medical attention.

Signature of Parent/Guardian: __________________________________________ Date:___________

***Please mail completed registration form and payment to:***

Randall Durant                                                   Contact Coach Durant at: 

215 Audra Circle                                                                                                                   817-706-3959 (cell)

Rhome, TX 76078                                                                                          randall.durant@kellerisd.net

                                                                                                      Team Website:      kellerhoops.ihigh.com