2010 Summer Camps 

INSURANCE WAIVER 

Every athlete must present a completed Insurance Waiver in order to participate in any of the activities organized by The Glenn Dolton Basketball Camp. It is our understanding that the Glenn Dolton Basketball Camp, its’ staff, and the organization providing the facility will not assume responsibility or obligation for any medical bills or debts resulting from any injury to the named player while participating in the Glenn Dolton Basketball Camp. 

We do/ do not (circle one) have private insurance for ___________________________________

                                                                                                     (Print Name of Athlete) 

_____________________________________________________(Name of Insurance Company)  

________________________________________________________________ (Policy Number) 

_______________________________________________ (Signature of Parent/ Legal Guardian)   

_________________________________________________________________________(Date) 

REGISTRATION FORM 

Camper Name __________________________________________________________________  

Address _______________________________________________________________________ 

______________________________________________________________________________ 

Age _____________________________      Entering Grade _____________________________ 

School ________________________________________________________________________ 

Home Phone Number ____________________________________________________________  

Emergency Phone Number ________________________________________________________ 

Email Address: _________________________________________________________________       

Shirt Size (Adult)    S     M     L     XL 

Camp(s) you are registering for:  #1 _____          #2 _____          #3 _____       #4 _____ 

Make payment to:  Glenn Dolton Basketball Camp - 625 Topsfield Road - Hatboro, PA 19040

Print this form and send it to the above address