Whitman Hanson Boys Basketball
Home of the Panthers!
http://www.whitmanhansonbasketball.com

PANTHER Basketball Camp

Camper Information

First Name *

Last Name *

Please choose a camp week *

Current Grade *

Age at Camp Time *

How did you hear about us?

Website

Hanson/Whitman Express

From a Friend

Other

If a High School player referred you, what was his name?

Parent/Guardian Information

Parent/Guardian Name *

Address 2

Town *

State

Zip

Email Address

An email confirmation will be sent upon receipt of your registration form.

Phone

Allergies *

Insurance Type & Number *

I give permission for my son/daughter to participate in the WH Panthers Basketball Camp; I understand that this league is not affiliated with Whitman-Hanson R.S.D in any way. I further agree to hold Whitman-Hanson, Coach Bob Rodgers, Coach Jim Daley, all coaches, camp counselors, officials and agents free from any liability whatsoever in the event of any type of injury; I also certify that my son/daughter has been through a physical examination within the last 13 months and that he is healthy and able to participate in the league; I also give my permission for the program to seek medical attention for my son/daughter in the event of an injury, but again will not hold the league or its agents liable for said medical care or lack there of.

Date *

Parent/Guardian Signature

Please bring a signed copy of this form with you on the first day of Camp. ALSO, please include a copy of a recent Physical Exam.

Payment Information

Send checks to Bob Rodgers (boys week) or Jim Daley (girls week and coed week), Whitman-Hanson Regional High School, 600 Franklin Street, Whitman, MA 02382; Or, to pay via PAYPAL: panthercamp@aol.com. (After filling out this form, go back to the website & Click on Paypal link.) *

$25 Deposit Girls/Boys Week

$25 Deposit COED Week

$175 Girls/Boys Week ($200 after June 1)

$100 COED Developmental Week