|
Long Island Basketball
Officials Camp |
| Please Print: |
| Name:
_________________________________________________________
Address: _______________________________________________________ _______________________________________________________ Telephone: ________________________ Experience: _____________________________________________________ _____________________________________________________ _____________________________________________________ Height: ______________ Weight: _________ Age: ________
Return form to: Sam Dominic Note - Participants must bring official shirts, shorts and whistle |
| I hereby release the staff of the Long Island Basketball Officials Camp of all liability from any injuries or illnesses while at camp. Further, I have no knowledge of any physical impairments that would be affected by my participation in the camp program. |
Signature ______________________________________ Date ______________________ |
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