Basketball camp 2

2017 Shawnee Heights Fall Basketball Camp

WHO: 1st-8th graders

WHAT: 1 day basketball camp

WHEN: Friday October 27th...No school!!! 8:00am-5:00pm

WHERE: Shawnee Heights High School-Main Gym (south gym)

COST: $30...that’s $3.33 an hour!

Questions? Please contact Steve Wallace at 785-764-9824 or This email address is being protected from spambots. You need JavaScript enabled to view it.

DEADLINE MONDAY OCT. 23RD!!!

--------------------------------------------------------Detach and Return With Payment------------------------------------------------

 Student Name(s):_______________________________________

Grade (s) (2017-18):_____________________________________

Father Name:__________________________________________

Mother Name:__________________________________________

 Father Cell:_____________________________________________

 Mother Cell:_____________________________________________

 Father Email:____________________________________________

 Mother Email:____________________________________________

Make check payable to: Steve Wallace

Address: Shawnee Heights High School

Attn: Steve Wallace 4201 SE Shawnee Heights Rd.

Tecumseh. KS 66542

RELEASE AND WAIVER OF LIABILITY As the parent or legal guardian of ______________________________________________ (student name-please print), I give consent for him to participate in the basketball programs conducted and/or sponsored by the Shawnee Heights Basketball. I understand that participation in basketball, and related activities involve certain risks, and may result in unavoidable injuries. The injuries may include muscle strains and tears, broken bones, and severe injuries including, but not limited to, permanent paralysis, or even death. I am fully aware of the risks and possibilities of injury involved and acknowledge that I am assuming the risk of such injury by my child’s participation in the academy. I further acknowledge that I will be responsible for any and all medical and related bills that may be incurred by me for any illness or injury that my child may sustain during the academy and while traveling to and from sites for the camp. I hereby release the Shawnee Heights School District and all of its employees from all claims that result from injury sustained during the 2017 Shawnee Heights Basketball Camp.

Parent(s) Name (please print):______________________________________________________________

Parent(s) Signature:__________________________________________________Date:________________