All
RED Fields Are Required For A Completed Application |
| First Name: |
Last Name:
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| Address: |
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| City: |
State:
Zip:
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| Phones: |
Please include area code:
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Email: |
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| Camper Info |
Height:
Weight:
Date of Birth (mm/dd/yyyy):
Age:
(Must be 25 or older) |
Basketball
Playing Experience: |
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| Sizes: |
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| Health Plan: |
Health Plan ID #:
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| Emergency Contact: |
Phone(s):
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| Deposit Amount : |
$
(minimum $500) We Accept Visa, MasterCard, or American
Express .
Total Fantasy Camp Fee is $2,395.00. Balance is due by August 31, 2010. |
The Fine
Print:
The staff of the Rick Barry
Fantasy Camp reserves the right to refuse admittance to
any applicant. This refusal will be based on the applicant's
failure to meet established eligibility criteria, such
as failure to provide a letter of medical clearance, failure
to provide proof of age, or payment of insufficient funds.
If a participant
wishes to cancel, the request must be accompanied by a
physician's notice of an injury or illness which would
prohibit participation. The $500 deposit is non-refundable.
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WAIVER I hereby hold Rick Barry Fantasy Camp, The entire Staff,
Sheraton Hotel and University of Sports free from all liability
should any injury or illness befall me while I am in attendance
at the Rick Barry Fantasy Camp. I also authorize the coaches
and staff of the Rick Barry Fantasy Camp to secure medical
treatment for me should I not be able to request treatment
for myself. I have no existing physical impairment that
would effect my participation in this program. In addition,
I authorize Rick Barry Fantasy Camp to use any photographs
of me taken during the program for use in publicizing or
advertising future Rick Barry events.
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Signature: |
Date Signed:
By entering name above and clicking submit
application button below certifies that I have read the "Fine
Print" and "Waiver" above. This will constitute
an electronic signature in lieu of an actual signature. |
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