Camper Name ________________________________________________ Boy ____Girl_____ Address__________________________________City________________State_____Zip_________ Camper Home Phone:_______________________Birthdate____________ Age as of 9/30/06_____ Current Grade__________#Years attended this camp________ (1,2,3,4,5) School Attending_______________________ Medical Problems?________________________ Parent/Guardian Name________________________________________ Work #________________ Parent / Guardian Address_____________________________  T-Shirt size   XS    S    M   L    XL Phone _______________________ Parent/Guardian  Email__________________________________ How did you hear about us ____________________________(Radio,Gazette,Fred Post, Friend, TV)

Name of Volunteer:___________________________________________ Phone#_______________
Email address _______________________________________________
Please check those that interest you:
Camp Parent:  Provides updates, posted on Web and announcements, to Campers ______
Registration Assistance: Help the league with Email, walk up and Phone Registrations______
Other: Assignments as needed ___________
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Registration Instructions:
1) Fill out form completely and legibly.
2) Parent/Guardian must sign Medical Release and Parent/Guardian player permission.
3) Fees are:  $30 per camper  No refunds after May 31, 2006.  Checks, Money order made payable to:  BCWB,  Mail Registration to :  P. O. Box 3528, Frederick, Md. 21705-3528. 

Medical Release and Parent/Guardian player permission :
I certify that my child is in good physical condition and is fit to participate in Basketball Coaches Without
Boundaries Youth Summer Basketball Camp;   Additionally,  

I understand that my participation in Basketball Coaches Without Boundaries activities involves risks basketball Coaches Without Boundaries, its Directors, Officers, Employees, Coaches, Officials, Volunteers, Agents, Sponsors, Advertisers, Owners/Lessors of Premises for any and all liability from my participation in these and any other Basketball Coaches Without Boundaries related travel, lodging, social/recreational activities.

Date: ____________            Parent/Guardian Signature  ________________________________