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					                          Lady Tiger Basketball
                            Summer Camp 2011
WHAT: Lady Tiger B-ball Camp, directed by MHS Coach-Natasha Stewart
WHEN: Monday, June 13th – Thursday, June 16th
WHERE: Mansfield High School – 3001 E. Broad St. Mansfield, 76063
TIME: 1st – 4th (8:30 am - 11:30 am)
        5th – 6th (8:30 am - 11:30 am)
        7th – 9th (1:00 pm - 4:00 pm)
COST: $65 bring a water container – wear a t-shirt, shorts, and gym shoes
           There will be a concession stand with drinks and snacks!
 Fill out the following registration form and mail it to: Natasha
 Stewart, Mansfield High School, 3001 E. Broad St., Mansfield, TX
 76063. Registration deadline preference is Friday, June 10th.

Please make checks/money orders payable to Natasha Stewart. Each camper will receive a t-shirt and a
camp ball. Call Natasha Stewart at 817-299-7593 with questions.

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                       cut out along the line and mail the form and payment to the MHS address above

I ___________________________________________ would like to enter my daughter in the Lady Tiger Camp.
            print parent first and last name

This form is to certify that I, parent or guardian of ______________________________________________, hereby
                                                                            name of participant
grant permission to Lady Tiger Basketball Camp to obtain medical care from any licensed physician , hospital, or
medical clinic for the player named herein if a parent or legal guardian cannot be contacted in person or by telephone.
This authorization shall include all camp activities, and we do hereby waive, release, absolve, indemnify, and agree not
to hold Natasha Stewart, Lady Tiger Basketball Camp, the organizers, supervisors, or participants responsible for any
claim arising out of injury to the player or accidents that may occur during the camp.

Parent Signature: _______________________________________________                      Date: _________________________

Parent’s email address: ______________________________________

Camper’s Name: ___________________________________________ Grade for 2011-2012 School Year: _________

Address _______________________________________ City: __________________________ Zip: _____________

Home Phone: _______________________ work or cell # Mom: __________________ Dad: __________________

Emergency Contact Person: __________________________________________ Phone: _______________________

Circle T-Shirt size:        Adult: SM          MED   LG     XL        or     Youth: SM        MED      LG

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