USA "JR SELECT" EARLY EXPOSURE BASKETBALL CAMP
Application/Enrollment
July 29 - August 1, 2006
 
   
Camp Selected: 
Name: (First,Middle,Last)
Mailing Address:  Apt:
City, State Zip:
Home Phone:
Email Address:
Parent's Business Phone:
Your Height:
Your Weight:
Your Age:
Your Birthday: (i.e. 12/31/1997)
T-Shirt Size:
Position on your Middle School Team:
Middle School Name:
Your Grade in Fall 2008:  
Middle School Mailing Address:  
City, State Zip:  
Middle School Coaches Name:  
Middle School Coaches Home Phone:  
High School You Will Attend:  
High School Mailing Address:  
City, State Zip:  
High School Coaches Name:  
High School Coaches Home Phone:  
High School Coaches Office Phone:  
AAU Team :  
AAU Coach :  
AAU Coaches Home Phone:  
Roommate Preference:  
In order to be officially enrolled in the USA "JR Select" Basketball Camp, your parent or guardian must complete the information below: Please list any physical limitations, allergies, etc. that need to be brought to the attention of the camp staff.

Insurance Information:
This is necessary if you have personal or family health insurance.
Name of Company:  
Policy No:  
Group No. (if applicable):