"SHOOTING STARS"

Registration Form

Name:__________________________

Parent's Name:___________________

E-mail: _________________________

Address:________________________

City:___________________________

State/Zip:_______________________

School/City:_____________________

Grade: (07-08)    4    5    6    7    8    9

                         (circle one)

[ ] Meteor Camp (4th-6th) 12:30-2:30 pm

[ ] Comet Camp (7th-9th) 12:30-2:30 pm

Check the Appropriate Box Above

Please fill out the permission to treat form to the right and send this page with $40 (please make checks payable to James McClellan) to:

GIRLS Basketball Camp

N.E.W. Lutheran High School

1311 S. Robinson Ave.

Green Bay, WI  54303

Questions?  Please Call:

James McClellan (S) 469-6810 or (H) 499-7581

I look forward to seeing your Shooting Star at camp!

Permission to Treat Form

I authorize camp and/or school personnel to transport my son/daughter to a physician's office and/or emergency room for treatment in the event that emergency medical care is needed while she is involved in the 2007 Shooting Stars basketball camp.  Further I authorize the PHYSICIAN and HOSPITAL STAFF to treat my daughter, as they deem necessary in the emergency situation.

Parent/Guardian Signature:

__________________________________

Date: _____________________________

Insurance Carrier:

__________________________________

Policy #:___________________________

Known Allergies:_________________________

Medical Conditions and/or Medications

_______________________________________

Father's Full Name: ________________________

Father's emergency phone:__________________

Mother's Full Name:_______________________

Mother's emergency phone:_________________

Family Doctor's phone:_____________________

Family Dentist's phone:_____________________

Shirt Size (circle one)  S      M     L     XL     XXL

SHIRT SIZES ARE ADULT SIZES