THE MIKE GLENN FOUNDATION FOR THE DEAF AND HARD OF HEARING
PERMISSION / MEDICAL RELEASE
Name of Camper________________________________________ Male/ Female
Date of Birth____________________ Age___________ Home Telephone ____________________
City ________________________ State _____________________
Zip Code ___________ School_____________________________
Emergency Contact Name and Number________________________________________________
Camper's Sneaker Size __________________________________
Behavior Policy by The Mike Glenn Basketball Camp
The Mike Glenn Basketball Camp for the Deaf promotes a safe, healthy, and respectful environment. We expect campers to behave with the highest character while in attendance. Therefore, we have instituted a policy of zero tolerance for bad behavior and disrespect. Campers are to follow the rules and directions of coaches and other adult camp staff at all times. Campers are to show consideration of others, graciously accept constructive criticism, and consistently try their best. All campers must maintain good hygiene, and pick up after themselves, including sleeping areas, bathrooms, parking lots, all gyms, and basketball court facilities used by the Mike Glenn Basketball Camp. Excessive arguing, fighting, vandalism, theft, or destruction of any property will not be tolerated. Boys and girls will not be allowed in each otherís dorms. Violation of this policy may result in the immediate dismissal of the camper.
Release / Acknowledgement
I hereby grant permission for as parent/guardian for_____________________________to attend the 2019 Mike Glenn Basketball Camp for the Deaf, June 16th - 21st . Please include his or her non-refundable registration fee of $25.00. A late fee of $25.00 dollars will be applied to any late registrations not received by the May 27th due date. Checks and Money Orders shold be made payable to the Mike Glenn Camp. In the unlikely event of an accident, I release the Mike Glenn Foundation, staff, facilities and all volunteers of responsibility. In the event the parent/guardian cannot be reached, I grant permission to have my child treated by a physician, if necessary. My child is physically fit, has medical insurance coverage, and has my permission to participate in all camp activities and travel. If camper has any specific allergies, specific needs or is taking any medication, please note such on the bottom of this form. Please note that all medications must be listed for our foundation to review and approve.
The Mike Glenn Foundation for The Deaf and Hard of Hearing
The Mike Glenn Camp for The Deaf frequently has videos and photography taken that may be used on local news, national media outlets, and the Mike Glenn websites. Videos and photographs taken for the Mike Glenn Basketball Camp for the Deaf, or during any outing remains the property of and under copyright to The Mike Glenn Foundation. Please check only one appropriate line
Please check only one
___ I give permission to Mike Glenn Basketball Camp to use any photo(s)
I have read, understand and agree to the terms and conditions set forth in this registration agreement and to the details included on the information pages.
Signature Parent/Guardian ________________________________, Date:___________