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THE MIKE GLENN FOUNDATION FOR THE DEAF AND HARD OF HEARING PERMISSION / MEDICAL RELEASE 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. 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. 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 2011 Mike Glenn Basketball Camp for the Deaf and Hard of Hearing, June 19th - 24th . 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. ____________________________________________________________________
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PROMOTIONAL RELEASE 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 ___ I give permission to Mike Glenn Basketball Camp to use any photo(s)
or video(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:___________
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