Tom Bryant Memorial Basketball Shooting, Fundamentals Camp Blank

                                                    Tom Bryant Memorial

                                  Basketball Shooting & Fundamentals Camp

An annual event for boys and girls to have fun and learn the fundamentals of basketball. All proceeds fund the Tom Bryant Scholarships.

For: Boys and girls in grades kindergarten through sixth grade.

Where: The Enlow Center, St. Anthony High School

Dates: january 6, January 13, January 20 (Sundays)

Times: Kindergarten, first grade, second grade, third grade, 10:45 a.m.-noon; Fourth, fifth and sixth gardes, 12:15-1:30 p.m.

Fee: $25 (Advance registration not required, but appreciated)

Instructors: St. Anthony coaches, assistant coaches, present St. Anthony players (boys and girls)

Please fill out this portion and mail it with your check (payable to the Tom Bryant Scholarship Fund) to: Tom Bryant Scholarship Fund, 912 Oakcrest Dr., Effingham, IL 62401

Questions? Contact Anita Baker at 347-7994.

Note: All funds will be used for the annual Tom Bryant Scholarships.

Student Name:_________________________________________________________

Grade: (Please Circle)                    K       1       2       3       4       5       6

T-shirt Size: (Please Circle)        YS (6-8)      YM(10-12)    YL (14-16)    AS    AM    AL    AXL

I hereby authorize the staff of the Camp to act for me according to their best judgment in any emergency that requires medical attention, and I hereby waive and release the camp from any and all liability for any injuries or illness occurred while at camp. I have no knowledge of any physical impairment that would be affected by the above camper’s participation in the camp program.

Parent Names:______________________________

Phone #_____________________

Parent Address:________________________________________________________

Parent Signature____________________________

Date:_______________________