Fredericktown Girls Basketball Camp scheduled




JUNE 19-21, 2017

9:00 AM-11:00 AM

FHS High School Gym


Cost: $30 (includes camp t-shirt) (Make checks payable to: FAB)

Camp is for girls 3rd grade through 7th grade (2017-18 school year)


Questions: Contact FHS Girls Basketball Coach Jim Lester

(740) 398-4742 or


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Name: __________________________________    Grade (next school year): ________________________


Address: ________________________________     Parent/Guardian: ______________________________


Phone: _________________________________     Shirt Size (circle):    YS    YM    YL    AS    AM    AL    AXL


Emergency Contact: ______________________     Emergency Phone: _____________________________


Medical Information for us to be aware of: ____________________________________________________


In case of emergency, do you want camp director to seek medical care? (circle one)       Yes          No


Physician: ______________________________      Phone: _______________________________________


Liability Waiver: I am aware that participation in the FHS Girls Basketball Camp has some inherent risks and injury can occur. In consideration of my child being allowed to participate in the FHS Girls Basketball Camp, I, the parent/guardian, assume the risk of all injury and agree not to sue FHS, the camp director, coaches, staff, volunteers, or trainer for any and all injuries caused by or results from participating in the FHS Girls Basketball Camp. By signing this waiver, I also authorize the use of a camp picture of the above-named participant to be posted on the Fredericktown website or advertising media published by Fredericktown.


Parent/Guardian Signature: _____________________________________          Date: __________________


Please return registration form with $30 payment by Friday, June 9th to: Jim Lester-Girls Basketball, c/o FHS, 111 Stadium Drive, Fredericktown, OH 43019 or send in with your child before school’s out.