Name of Camper________________________________________ Male/ Female

Camper's Sneaker Size __________________________________

Parent/Guardian _______________________________________

Address _______________________________________________

City ________________________ State _____________________

Zip Code ___________ School_____________________________

Date of Birth____________________ Age___________ Home Telephone ____________________

Emergency Contact Name and Number________________________________________________

Zero Tolerance Policy by The Mike Glenn Basketball Camp

The Mike Glenn foundation has executed a zero tolerance policy for all campers. Campers must speak and act with dignity at all times. You are representing your school, parents, and The Mike Glenn Foundation. You are asked to show consideration of others, graciously, accepting constructive criticism and consistently trying your best.

All campers must perform good Hygiene, be responsible for picking up after themselves which include; their sleeping area, bathrooms, all parking lots, all Gyms and Basketball Court facilities that may be used by the Mike Glenn Basketball Camp.

No disrespecting anyone, coaches, camp volunteers, staff, your peers or housing. No fighting, vandalism or destruction of any property, personal or otherwise will be tolerated. Under "NO" Circumstances will any male or female campers be allowed to stay in either the girls or boys gyms without supervision from the coaches or Mike Glenns approval.

Violation of this policy will result in the immediate dismissal of said person (s) with no future Considerations of being invited back to The Mike Glenn Basketball Camp. This policy holds true for everyone. Anyone that cannot abide by this zero tolerance will be ask to remove themselves with no future Considerations of being invited back as well.

I have read the Zero Tolerance Policy and agree to the terms above. If my child or children becomes a problem and violate this policy, we will abide by the penalties imposed and the decisions handed out by The Mike Glenn Foundation.

Release / Acknowledgement

I grant permission for my child, _____________________________to attend the 2018 Mike Glenn Basketball Camp for the Deaf and Hard of Hearing, June 17th - 22th . 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 due date. 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, 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.

Prescription Medications


Hearing Device and ID#
(ie..Cochlear, Hearing Aids...etc)


Dosage and times taken per day

Signature of Parent/Guardian




The Mike Glenn Foundation for The Deaf and Hard of Hearing

All video(s) and photograph(s) images taken for the Mike Glenn Basketball Camp, or during any outing remains the property of and under copyright to The Mike Glenn Foundation.

Please check only one
appropriate line

___ I give permission to Mike Glenn Basketball Camp to use any photo(s) or video(s)
images of my son or daughter for the purpose of marketing.

___ I do not give permission to Mike Glenn Basketball Camp to use any photo(s) or
video(s) image of my son or daughter for the purpose of marketing

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.

Name of Camper _________________________________________, Male / Female

Signature Parent/Guardian ________________________________, Date:___________

Please return permission form and registration fees to your Coach or mail to the address below by May 19, 2018

Mail all forms and registration fees to:
Mike Glenn
P.O. Box 390313
Snellville, GA 30039-0313