Derrick Price Basketball Camp Registration

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Name & Phone Number
Company & Policy Number

I hereby approve of my son's / daughter’s attendance at Derrick Price’s Basketball Camp and certify that he/she is in good health and able to participate in program activities.  I authorize the Director to act for me according to their best judgement in any emergency requiring medical attention, for which services I will be responsible to pay. I hereby waive,  release and hold harmless Derrick Price, its participants, officials, directors, coaches and staff from all causes, liabilities, damages or claims or demands whatsoever on account of any injury or accident involving my son/ daughters arising from his/her participation in the basketball camp at Bluefield State College. By submitting this application I hearby agree to all policies set forth and stated by the Camp Directors.

Prices: $60.00 Early Bird Special (Register by June 16th); $70.00 after June 16th

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