Print Form & Mail to Address Below

DreamMakers Basketball Camps: Spring Break /Summer Camp # 1                Summer Camp # 2 (ages 7-17)

Summer Day Camp1 or 2: ___ Total Fee before April/June/July/Aug/Dec ____,  2006)
Summer Day Camp plus Before & After-Care: ____ Total Fee

School Level: Elem. ____ Middle ____ Junior Varsity ___ Varsity H.S. _____

Name of School, AAU or County Team _________________________

Name: ___________________________________

Address:___________________________________

City:_________________________ State _________ Zip __________

Home Phone: ___________

Age: ________

Grade in Sept. 2004 :______

Uniform Size Shirt _______ Shorts _______ (S, M, L, XL, XXL, 3X) Adult Sizes

Parent/Guardian Name _______________________________

Parent/Guardian Daytime Phone # (____) _____ - _______

Email address ___________________________

Fax # (_____) ______ - _________

Did you attend any DreamMakers events last year?

List any medical information we should be aware of:

Waiver: I hereby give permission for the staff of DreamMakers Academy camp to seek appropriate medical care in the event of an accident, illness, or emergency. The parent / guardian is responsible for paying the outstanding amount of the bill not paid by the camp's insurance policy. Signature of Parent or Guardian is required.

Parent or Guardian ____________________________________________________________

Amount Enclosed ________ (check/MO; no cash please) Check Number _________
Make check payble to "Willie Diggs"

Date ______________

Return Registration Form to: Willie Diggs