2008 Dick Shilts Basketball/Shooting Camp Application Form
(Camps Are Held at Kalamazoo Valley Community College)
Please use one form for each camp & applicant you are signing up. You may make as many copies of this form as necessary.                    

Camp (Circle One) Men's All Day Camp Shooting Camp
     
Date July 21-25, 2008 July 14-17, 2008
Cost $150 $95
Name >
Address >
City, State, Zip >
Grade in Fall: Birthdate: Phone:
Age at time of camp: Sex:   _____M          _____F Email:
Emergency Contact >
Emergency Phone >
Parent/Guardian Approval X (sign here)_________________________________________________________________

Waiver: By signing this application I am declaring that I understand that inherent in this activity is the potential for injury.  I further represent that my child is physically and emotionally capable of fully participating in all activities associated with the camp.  I acknowledge and agree that Dick Shilts, his employees, agents and contractors, has not made, and has no obligation to make, any determination as to my child's fitness for participation in this activity and that Dick Shilts, his employees, agents and contractors, shall not be liable for any loss, injury or death related to my child's attendance and participation.  My signature on this document further indicates my permission for my son/daughter to have his/her picture displayed on the www.dickshilts.com website.

Medicals: Each applicant  is encouraged to have had a physical check-up within the last year. A medical statement from a physician will not be required.  Parents will be required to sign a waiver indicating applicant's capability to fully participate in camp activities.

Make Checks Payable To & Mail To:  Dick Shilts Basketball Camp
                                                             2949 Sunset Road
                                                             Kalamazoo, MI 49009-1827
Amount Enclosed: __________________
Enroll early to hold your spot!
For more information you may call (269) 375-7890.  You may also request an application via e-mail at  dcshilts@hotmail.com  (This entire page will print on one sheet of paper with margins set at .5)  [Return to information page]     [Home Page]