Women's Basketball Camp

Date: (mm/dd/year)
PLAYER INFORMATION
Name:
Age:
High School:
Position:
Height:
Phone Number: (include area code)
Email:
EMERGENCY CONTACT INFORMATION
Emergency Contact #1 Name:
Emergency Contact #1 Phone Number: (include area code)
Emergency Contact #2 Name:
Emergency Contact #2 Phone Number: (include area code)
INSURANCE INFORMATION
Name of Insurance Company:
Insurance Company Address: (street and city)
Policy Number:
Policy Holder:
MEDICAL INFORMATION
Allergies:	select one yes no
Medical Conditions:
Any additional information you would like to provide?