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Name:____________________________Home Phone: ______-______-_________ Address:____________________________________________________________ City:_______________________________State:_________________ Zip:_________ Age:_____________Height:______________Weight:_______________Sex:_________ School:_________________________________________________Grade:___________ I wish to attend June 22-26 _____ July 20-July 24 _____ Boarding ______ Day______ Roommate Request _____________________________________________________ I hereby release and waive the right to hold liable all sponsoring agencies, individuals, and Oak Hill Academy from any claim for injury or damages which may occur form participating in the Steve Smith Oak Hill Academy Basketball Camp. I certify that my child is in proper physical condition to participate in this camp. Parent/GuardianSignature:______________________________Date:____/____/______ Emergency Number:______________________________________________________ |
Print this Application and mail along with deposit to:
Oak Hill Academy
2635 Oak Hill Road
Mouth of Wilson, Va
24363-3004
Phone: (276)-579-2619
Fax: (276)-579-4722
E-mail:
Warriors@Oak-Hill.Net