PRINTABLE APPLICATION
<PRE>


Camper ____________________________________________

DOB _____________

Age _____________

Address____________________________________________

___________________________________________________

City ______________________________________________

State ________________Zip Code ____________________

E-mail Address ___________________________________

Parent/Guardian (1) ___________________________________

Parent/Guardian (2) _______________________________

Home Phone (1)  ________________________________________

Home Phone (2) ____________________________________

Work Phone (1) ________________________________________

Work Phone (2) ____________________________________

Emergency Contact # _______________________________

T-shirt size:  ___S, ___M, ___L,___XL, ___XXL

Please check one or both:

___Week 1 (June 19-23)

___Week 2 (June 26-30)</pre>
<P>
<table width=350 cellspacing=0 cellpadding=0 border=0>
<tr><td><font
 size=2 face="arial, helvetica, sans serif">
I CERTIFY that my child/participant is physically able to participate
in all activities at the GW Basketball camp.  I understand that every
effort is made to protect the  health and safety of the campers through
supervision, trained staff and inspection of equipment and that the camp
assumes no responsibility for accidents or illness.
I agree to all of the conditions stated above.<BR></td></tr>
</table>
<P>
<pre>
Date _____________________________________________

Signature ________________________________________

</pre>