2018 MVBC Basketball Camp - June 18-22
 
2018 MVBC Basketball Camp - June 18-22
Child #1 Last Name  * 
Child #1 First Name  * 
Child #1 Age  * 
Child #1 Birthday (mm-dd-yyyy)  * 
Child #1 Gender  * 
Child #1 Completed Grade  * 
Child #1 T-Shirt Size  * 
Child #1 Special Concerns (i.e. - Allergies, Medications, Medical Conditions, etc.)  * 
Add Child #2?  * 
Child #2 Last Name
Child #2 First Name
Child #2 Age
Child #2 Birthday (mm-dd-yyyy)
Child #2 Gender
Child #2 Grade Completed
Child #2 T-Shirt Size
Child #2 Special Concerns (i.e. - Allergies, Medications, Medical Conditions, etc.)
Add Child #3  * 
Child #3 Last Name
Child #3 First Name
Child #3 Age
Child #3 Birthday (mm-dd-yyyy)
Child #3 Gender
Child #3 Grade Completed
Child #3 T-Shirt Size
Child #3 Special Concerns (i.e. - Allergies, Medications, Medical Conditions, etc.)
Parent #1 Last Name  * 
Parent #1 First Name  * 
Parent #2 Last Name
Parent #2 First Name
Street Address  * 
City  * 
ZIP Code  * 
Home Phone # (xxx-xxx-xxxx)  * 
Parent #1: Cell Phone (xxx-xxx-xxxx)  * 
Parent #2: Cell Phone (xxx-xxx-xxxx)
Emergency Contact Name  * 
Emergency Contact Phone #  * 
Primary Insurance Company  * 
Insurance Group Number  * 
I have printed, read, and signed the Parental Consent and Medical Authorization from the MVBC website (please send with your child on the first day they attend camp).  * 
Your Email Address  * 
Base Price $
Modifications $
Total $
 
 
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