Camper's Name:

Parent's Name:

Street Address:

City: ...................................................... State:............. Zip:
.. ..
Phone Number (with area code):............Age:
..
E-mail Address:

School/Church:

Insurance Company::

Policy #:

*I hereby grant permission for my child to attend the 2007 BSM Camp. I also grant permission to BSM Staff to act for me according to their best judgment in any emergency requiring medical attention and hereby waive and release BSM, its employees, and the Camp Directors from any and all liability for any injuries incurred while at BSM Sports Camps. I will be responsible for any and all costs of medical attention and treatment. I also grant permission to a medical facility to treat my child in the event this becomes necessary. I have provided the necessary insurance information, and in the event that insurance will not cover necessary treatment, I will be responsible for any and all medical attention and treatment.

I agree to the above statments.  

 

T-Shirt size: YS YM YL S M L XL

*Add't shirts $10

 

Please Check Sessions(s)

June 11-15

Coed Soccer (ages 5-7) .....................................9am - 12 noon

Coed Soccer (ages 8-10) .................................1pm - 4pm
June 18-22

Girls Basketball and Volleyball (ages 10-13)......................9am - 4pm

July 9-13

Coed Basketball (ages 5-7)...............................9am - 12 noon

Coed Basketball (ages 8-10)...................................1pm - 4pm

July 16-20

Girls Basketball and Volleyball (ages 14-17)..............................9am -4pm

July 23-27

Coed Baseball (ages 5-7).................................9am - 12 noon
Coed Baseball (ages 8-10)..................................1pm - 4pm

Open Dates for Basketball/Soccer/Volleyball Team Camps

August 6-10
August 13-17
August 20-24

*A non refundable deposit of $20 must accompany your application in the form of a check or money order (do not send cash in the mail). Make payable to: Breakaway Sports Ministries, P.O. Box 26383, Greenville, SC 29616

 

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