BULLITT EAST SKILLS CAMP ENROLLMENT FORM

Name________________________________ Grade (Fall ’19) ____

Address ___________________________________ Age _____

City ______________________________ State _____ Zip _____

School Attending (Fall ’19) ________________________________

T-Shirt Size (check one): □ youth small □ youth medium

□ youth large

□ adult small □ adult medium

□ adult large □ adult XL
□ adult XXL

Emergency Contact:
Name____________________________ Phone # _____________

Insurance Co. __________________________________________

Policy # _______________________________________________

Alternate Contact Phone # ___________________________

I, _______________________, the parent/legal guardian of the child

named above, do hereby release the Bullitt County Board of Education/
Bullitt County Public Schools, its employees, camp sponsors, coaches,
and volunteers from all liability of any nature for injury or damage that
may occur during or as a result of participation in the Bullitt East High
School Basketball Skills Camp.