Presbyterian Christian School
Boys 2017 Basketball Camp
DATE
CAMP NAME
Location
GRADES
(2017-2018)
TIME
CONTACT
COST
July 19th - July 21st
Boys Basketball
PCS Rees Gym
Incoming
2nd – 4th
8:30 am - 11:30am
[email protected]
601-475-6010
$75
July 19th - July 21st
Boys Basketball
PCS Rees Gym
Incoming
5th - 7th
1:00 pm - 4:00 pm
[email protected]
601-475-6010
$75
Please complete the application below for each camp you would like for your child to attend. The application form
may be duplicated. Make sure to return each form along with payment. Please make all checks out to PCS.
Student's Name: ______________________________________________ M_____F_____
T-shirt size:(Circle One)
YS
YM
YL
YXL
AS
AM
AL
AXL
AXXL
Address: _____________________________ City: _________________ State: ______ Zip: _______
Date of Birth:______________________________Home Phone: _____________________________
Parent/Guardian Name:_______________________________________________________________
Work/Cell Phone (Father): ____________________ (Mother): _______________________________
School 2016-2017: __________________________________________________________________
In case of emergency, contact: ____________________________ Phone:______________________
Allergies: ______________________________________________________________________________
In consideration for allowing my child to attend the indicated camp, I
_____________________ (parent/guardian) hereby release and discharge PCS, its agents,
trustees, and representatives from any and all liabilities, damages, costs, expenses, actions,
causes of actions, and/or suits of any kind or nature arising out of my child(ren)'s
participation in the camps.
_______________________________________
Signature
_______________________
Date
Please return form and payment to the high school office, or mail to:
Presbyterian Christian School
Att: Josh Dorman – Boys Basketball
221 Bonhomie Road
Hattiesburg, Mississippi 39401
Additional registration forms may be downloaded from www.pcsk12.org. Unless the camp director is notified
otherwise in writing, it is assumed that permission is given for photographs and videos of camp participants to
appear in any media.