Fill out form completely and mail along with your money order or cashier’s check payment, payable to Jr All-American Camp. See address below. If paying with credit card, use PayPal. Send to email address: info@bamajrallamericancamp.com. No processing fee if mailing in.

Name____________________________________________________________

Address__________________________________________________________

City_________________________ State_____ Zip________________________

Home Phone____________________ Cell Phone__________________________

Email 1____________________________ Email 2_________________________

DOB___/___/______ Height______ Weight______ Position (circle one)  G     F     C

Grade in 09-10_____ School 09-10______________ City, ST _________________

Travel Team________________________________________________________

Coach’s Name_____________________________ Cell______________________

Coach’s Email_________________________ Team Website__________________

Uni Top (adult)    M     L     XL     2XL     3XL      Uni Shorts    M     L     XL     2X     3XL

Insurance Information

Carrier____________________________________________________________________________

Policy#___________________________________ Group#__________________________________

Emergency Contact____________________________________ Phone________________________________

I, the undersigned, submit that my son is physically fit and able to participate in strenuous activity and hereby waive Bama Hoops 1, University of Alabama Birmingham and Jr All-American Camp of all responsibility for illness or injury sustained.  I hereby authorize camp personnel and directors to act on my behalf in their best judgment in any medical situation.  I understand I am solely responsible for payment of any such medical expenses and must provide Bama Hoop 1, UAB and Jr All-American Camp with proof of medical and accident insurance.  I also understand that my payment is non-refundable and non-transferable under any circumstances.

Parent signature______________________________________ Date_____________________

Jr All-American Camp ? 140 Main St ? Birmingham, AL 35213 ? Email: info@bamajrallamericancamp.com