Camp sign-up form
April 7, 2009 By Randall Durant of Keller High School
KELLER INDIAN BASKETBALL CAMPS
Camp Director: Randall Durant Head Boys Basketball Coach- Keller High School CAMP DATES: JUNE 15th-18th, 2009
AT KELLER HIGH SCHOOL: Session I: Incoming 1st-5th graders 9:00-12:00 Session II: Incoming 9th graders 2:00-5:00
AT INDIAN SPRINGS MS: Session III: Incoming 6th-8th graders 9:00-12:00 Session IV: Incoming 1st-5th graders 2:00-5:00
**********Cost for each session is $85. Make checks payable to Keller High School***********
Name: ____________________________________________ Grade (next year): _____
Address:_______________________________________________________________
Phone #:______________________________ Emergency Phone #:______________
Session(s) Attending (circle one): Session I Session II Session III Session IV T-shirt Size (circle one): Adult Sm OR Youth Sm Adult Med Youth Med Adult Lg Youth Lg Adult XL
I acknowledge that _______________________________ is physically able to participate and I hereby authorize the camp directors to act for me according to their best judgment in any emergency requiring medical attention. Signature of Parent/Guardian: __________________________________________ Date:___________
***Please mail completed registration form and payment to:*** Randall Durant Contact Coach Durant at: 817-744-1462 (office) 215 Audra Circle 817-706-3959 (cell) Rhome, TX 76078 randall.durant@kellerisd.net Team Website: kellerhoops.ihigh.com | 
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