Make check payable to: Think A.H.E.A.D., Inc.
Return to: Byron Samuels Basketball Camp
Radford University
P.O. Box 6913
Radford, VA 24142
(540) 831-5124
NAME____________________________________________
STREET__________________________________________
CITY_________________________STATE____ZIP________
HOME PHONE______________________________________
SCHOOL__________________________________________
GRADE NEXT YEAR_________________________________
HT___________WT__________ DOB___________________
PARENT'S WK PH#_________________________________
PARENT'S CELL PH#________________________________
I have___have not___ earned an athletic letter since entering the ninth grade (check one).
I will:
______ Board on campus
______ Attend as day camper
T-shirt size: SM___ MD___LG___ XL___XXL___
$50.00 DEPOSIT REQUIRED
A registration fee of $50.00 must accompany this application. The fee is non-refundable and will be credited toward the tuition fee of $250.00 boarding/$185.00 day. The remaining balance must be paid by cash, personal check or money order on the first day of camp at registration. All campers must complete and return the application, waiver and release form and the medical release form in order to participate in camp.
Parent/Guardian Signature_______________________________
Office Use Only:
Amt. Paid_______ Bal. Due________D_____B_____
WAIVER AND RELEASE
We, the undersigned, for ourselves, our heirs, executors and administrators waiver, release and forever discharge the Byron Samuels Basketball Camp, or Think A.H.E.A.D., Inc., its staff, officers, agents, representatives, employees, successors and assigns of and from any and all rights and claims for dangers resulting from injury to person or property which may be sustained or occur during participation in camp activities, or arising from traveling to and from the camp, whether said damages, injury or loss is due to negligence or not.
Parent/Guardian Signature_______________________________