Ohio - Registration

When registering for the "Yes, I Can!" basketball camp you can either fill out the form on the brochure or fill out this web registration below. If you choose to fill out the form provided below you will need to type the information in the spaces provided and then print the completed form with parent signature and deposit and send it to:

Bill Immler
6301 Fiesta Court
Lorain, Ohio  44053

Cancellation Fee $25.00. (Deposit forfeited if cancellation occurs after June 1st.)

Camper's Name:     E-mail Address:

Address:                 City/State/Zip:     

Home Phone#:   Parent's Work Phone#:  

School:     City/State:     

Athletes grade as of Sept. 2007: 6th 7th 8th Freshman Sophmore Junior Senior     Age:    Sex: M F  

Height:     Position:     

Resident Camper (Stay in dorm):    Commuter  Camper (not staying in dorm):

A $189 deposit required / balance of $200 due first day of camp  (Make checks payable to "Yes, I Can!") 

Amount    Enclosed:        Request School Team: Yes     No

Most campers will be in 2-4 person rooms. Upon request, friends will be placed in adjacent rooms. 
Roommate preference:
#1    #2     #3

*If any special medical considerations are required for your participating athlete, please attach a separate note explaining the requirements.

I authorize the staff of "Yes, I Can!" Basketball Camp to act according to their best judgment in any emergency requiring medical attention and I waive and release the Camp from any and all liability for any injuries or illness incurred while at Camp. I have no knowledge of any physical impairment that would be affected by the above named camper's participation in camp. I also give permission to the licensed physician selected by the camp staff to hospitalize or to secure proper treatment, anesthesia or surgery for my child in an emergency.

________________________________    _____________                                                    

Parent or Guardian Signature                               Date