ProStar Basketball Camp Registration Form

We (I) request that you accept the application of our son/daughter for the ProStar Basketball camp. We (I)
Hereby release Blue Valley District Service Gym and the ProStar Basketball instructors from all claims on account
of any injuries which may be sustained by our (my ) son/daughter while attending or travelling to or from the
Basketball Camp.

Parent Signature: _________________________

Camper Name: ___________________________

Male ____ Female ____

Address: ________________________________

City: _______________________________

State: _____________ Zip: __________

Phone: ______/______________

Email: ______________________________

School Attending:__________________________

Grade: _______________ Years Experience:____

Age: _________ Height: ____/_________


Shirt Size: (Adult sizes only) M L XL