LNGB Camp Registration

Indiana Blaze

Lawrence North Girls Basketball

Student Name *

Email *

Website *

Number Cell *

Email *

Company *

T-Shirt Size *

Camp Weeks (Check All That Apply) *

Week 1 - June 4th - 7th

Week 2: June 11th - June 15th

Week 3: June 18th - June 21st

Week 4: June25th - June 28th (Shooting Camp)

Message *

Phone *

WAIVER (REQUIRED): I do hereby waive, release, and discharge Lawrence North High School, camp director Christopher Giffin, and respective staffs and employees from any and all rights and claims for damages resulting from injuries to my person or property which may be sustained or suffered by me in connection with my association with, or participation in, or arising out of my traveling to or from the Lawrence North girls’ basketball camp. We, the parents or guardians, agree to the above waiver and release. The participant has family health insurance. I give my child permission to participate under these conditions. (TYPE YOUR NAME HER TO AGREE TO THE WAIVER) *

Signature for Online Registration *

Message *

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CONTACT INDIANA BLAZE

P.O. BOX 7020

Fishers, In 46037

T. (317)456-7700

E. score@indianablaze.com

W. www.indianablaze.com