To register, return this form or contact:
Assistant Coach Matt Green
434-223-6168
mgreen@hsc.edu

Hampden-Sydney College
P.O. Box 698
Hampden-Sydney, VA 23943

High School:        ___________________________________________________

School Address:  ______________________________________________________
  ___________________________________________________________________
  ___________________________________________________________________

School Phone:      ______________________________________________________

Coach's Name:    ______________________________________________________

Coach's Home Phone:  __________________________________________________

Coach's Cell Phone: ____________________________________________________

Number of teams you plan to bring:  ________________________________________

* A $400 deposit per team is required by May 2 to reserve spot.  Failure to do so will result in a forfeit of camp spot. We will accept the first 32 teams (not schools) that respond.

Medical Form

Name:      ___________________________________________________________

Address:   ___________________________________________________________
  __________________________________________________________________
  __________________________________________________________________

Phone #:   ___________________________________________________________

Medical Information (To be completed and signed by camper's physician)

 _____________________________________ (name) is physically able to participate fully in athletic activity at Hampden-Sydney Basketball camp. His/Her physical condition is
(Good)  (Average)  (Poor).

He/She has the following special conditions to be aware of:
 __________________________________________________________________

He/She must take the following medications:  __________________________________________________________________

He/She must have the following routine in his diet or activity: __________________________________________________________________

Allergies: ___________________________________________________________

Additional comments or special needs: _____________________________________
  __________________________________________________________________

Doctor's Signature: _________________________________ Date: ______________

Parental Permission

Swimming:

 _____________________________________ (name) does / does not have my permission to swim at the Hampden-Sydney pool under supervised conditions.  His / Her swimming ability is (Good)  (Average)  (Poor).

Parent Signature: __________________________________ Date: ______________

Emergency Care:

I hereby authorize the staff of Hampden-Sydney Basketball camp to act in my behalf in the event that I cannot be reached in an emergency.  I hereby waive and release the H-SC Basketball Camp from any and all liability for injuries or illness sustained during any session. 

Parent Signature: __________________________________ Date: ______________