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Name __________________ _________________
Address _____________________
_________
City
____________________ __
Zip ________
Phone( ____ ) ________________
e-mail
____________________________________
___________
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 all 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
Girls Basketball Camp
to act for me according to their
best judgement,
in any emergency requiring
medical attention;
and I hereby release,
exonerate, and discharge
LHNW Girls Basketball
Camp and its employees from any action,
known or unknown,
for any injuries while at LHNW Girls Basketball Camp.
Parent or Guardian
Signature
(Required):
Insurance:
Group No.
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