Please print this page, complete the application, the medical release form and choose your camp session(s). Mail the completed form along with a $75.00 NON-REFUNDABLE DEPOSIT for EACH camp to Valley All-Star Basketball Camp, Box 97, Bridgewater College, Bridgewater, VA 22812. When we receive your application and deposit, we will send a confirmation letter.

Name____________________________________ Phone(___)____________

Email_______________________________________ Age ____________

Address__________________________________________

City_______________ State_______________ Zip_____________

Roommate Preference____________________________________________

School you attend_______________________________________________

Grade in Fall '07 ___________ Circle one: Male Female

Shirt Size, Circle one: S M L XL (adult sizes)

[ ] Check if you have previously attended our camp

[ ] Will this be your first year in camp?

CHOOSE YOUR CAMP

[ ] June 22-24 Session I, Co-Ed Shooting Camp (boys & girls 10-18)

[ ] Overnight, [ ] Day

[ ] June 24-26 Session II, Co-Ed Offensive Skills Camp (boys & girls 10-18)

[ ] Overnight, [ ] Day

[ ] June 29-July 3 Session III, Boys Overnight, Evening, or Day Camp(boys 8-18)

[ ] Overnight, [ ] Evening, [ ] Day

Medical Release Form For (Players Full Name):_____________________________

NOTIFY IN CASE OF EMERGENCY

In the event my son/daughter suffers any illness or accident requiring hospitalization, medical treatment of medication, I hereby give my permission for any medical treatment which may be deemed necessary and reasonable under the circumstances.

Signature of Parent or Guardian_____________________________________

Health Insurance Company_____________________________________

Policy Number_____________________________________

Group Number_____________________________________