Phenom150 Camp Registration & Biography Form

** All fields are required! Staff reserves right to refuse camper's registration if form is missing data.

Camper's Name (Boys):			Approval Code:
First:		Last:
Address:
City:		State:	Zip:
Phone:		Cell:
Email:

School Team:	GPA:
Travel Team:		Birthdate:
Position:		Ht: Wt:
Gender:	Male
Classof:	2011 2012
Allergies:
Medications:
Emergency Contact:
Uniform Size:	(adult size; comes in a set)

Insurance Information:
Carrier:
Policy#:	Group#:

I understand and acknowledge that the camp is being produced and directed by the Nashville Celtics Basketball Association, a Tennessee not for profit association. I submit that my son is physically fit and able to participate in strenuous activity and hereby waive and release adidas Phenom150 Camp, the Tennessee Phenom Camp and the Nashville Celtics Basketball Association, of all responsibility for illness or injury sustained. I hereby authorize camp directors to act on my behalf in their best judgment in any emergency medical situation. I understand I am solely responsible for payment of any such medical expenses and must provide proof of medical and accident insurance. I understand that my payment and deposit is non-refundable, non-transferable under any circumstances, including injuries sustained, conflict of schedules, or illness. I understand that Phenom products can not be given in lieu of any refunds. I also understand that any camper who does not abide by camp facility rules or regulations is subject to dismissal without refund or recourse. I intend to be bound by my electronic signature if this application is submitted on-line.
Parent/Guardian Signature: /S/ Date:
Note: If you register on-line, you must type your signature and date above and agree to be bound by your typed signature.


Camp Fees:	-- $195 (Cashiers Checks payable to: TENNESSEE PHENOM CAMP)
Items You Provide in the registration packet:
	º Proof of grade (report card, letter from school or progress report)
	º 3 x 5 photo (no computer printouts)
	º Completed Biography
	º Registration form
	º Registration fees or deposit
Send Registration to: Phenom150 Camp, PO Box 9351, Nashville, TN, 37215-9351






Player's Name:
Address:
City, St, Zip:
Contact Info:	Phone: email:
School Team:
Travel Team:
Position:
Height:
Weight:
Class:	2011 2012
Hobbies:
Fav Athelete:
Nickname:
	Registration Artifacts Checklist:		ATTENTION PARENTS: Click the "Send Artifacts" button below to send your child's proof of grade and photo to us via email attachment:
	Registration Form
	Biography Form
	Proof of Grade
	Registration Deposit/Fees
	Photo for Camp Program
	* These items must be submitted in full for registration to be accepted. Please check items before submitting.*
and mail it in OR and continue to online payment site