Boy's Basketball Camp Application form

Enclosed is the $100.00 application fee which will be subtracted from the total cost or will be refunded if facilities will not permit acceptance.

Please make checks payable to:  
Taylor Basketball Camp

 Please print/mail form to:
Taylor Basketball Camp
P.O. Box 201
Upland, IN  46989

or fax form to:  765.998.4920 (credit card only)
 

Please call the Athletic Department at 765.998.5312 if you have any questions.

 
Date of application ____________
Name _______________________________________________________________
Address _______________________________________________________________
City _______________ State ___________ Zip _______________
Phone (___)____________ Emergency
phone		 (___)___________
Father's Full Name ________________ Mother's Full Name ________________
  E-mail Address:_________________________________________
Age at camp time _______ Grade next fall _______ # of previous yrs. at this camp _______
Height _______ Weight _______
How you learned of camp _______________________________________________________
Church preference ______________________ Roommate pref. ______________________
Week pref.: 1st choice ______________________ Week pref.: 2nd ______________________
 Check Enclosed Credit Card
No debit cards accepted
Card type Mastercard Visa Exp. date: _______           Payment Amount  __________
Card # ___ ___ ___ ___     ___ ___ ___ ___     ___ ___ ___ ___     ___ ___ ___ ___
 
Signature: ____________________________________