Name                                   
                               Address                                                                    
City                                     
Zip                    Phone(      )                    
I will be entering           grade at
                                                                            
in the fall of 2008.
T-shirt size (Adult sizes, Please Circle One)
S      M     L    XL    XXL
Cost: $45 for all registrations in the school
office by May 23rd.
$55 for registrations received after the 23rd.
Make checks payable to:
Lutheran High Northwest
1000 Bagley
Rochester Hills, MI. 48309
(248) 852-6677

Questions, Contact:
Don Justice - Athletic Director
Gisela Baldwin - Athletic Secretary

I hereby authorize the directors of LHNW Basketball Camp
 to act for me according to their best judgments,
 in any emergency requiring medical attention;
and I hereby release, exonerate,
and discharge LHNW Basketball Camp and its employees
from any action, known or unknown,
for any injuries while at LHNW Basketball Camp.

Insurance:

Group No.

Parent of Guardian Signature
(Required):

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