2021 Boy's Comet Basketball Camp

COMET BOY'S BASKETBALL CAMP
JUNE 28 - JULY 1, 2021

9:00 am -12:00 pm

OPEN TO BOYS AGES THIRD GRADE - RISING FRESHMAN

CLAYTON HIGH SCHOOL GYM

COST: $75.00 PRIOR TO JUNE 21

$90.00 ON JUNE 28

MAKE CHECKS PAYABLE TO COMET ATHLETIC BOOSTER CLUB
Name
Age
Parent/Guardian
Address

Address

Street Address Line 2

City State

Zip
Home Phone
Work Phone
Email
T-Shirt Size

YM YL AS AM AL XL XXL
Position
School Attended
Grade Completed
Insurance Company
Policy Holder
Primary Physician
PARENT AND MEDICAL CONSENT / RELEASE
My child has my permission to attend the 2021 CHS Basketball Camp. In the event of illness or injury, I hereby grant permission for the attending physician or appropriate medical personnel to secure proper treatment. I will be responsible for any medical or other charges connected with my child's attendance at camp. In acceptance of this applicant for camp, I hereby release Clayton High School and all its employees from all claims or damages that may be sustained by my child in association with this camp.
Is there a history of:
Medical conditions currently under treatment

Yes No
Pre-existing injury currently under treatment

Yes No
Fractures or other disability type injuries

Yes No
Any medications presently being taken

Yes No
Allergies (drugs, bee stings, food, asthma)

Yes No
Mental disorder or physical handicaps

Yes No
Known past illness of more than one week

Yes No
Contact lens or glasses

Yes No
Explain above questions answered "yes".
I hereby state that the CHS Basketball Camp and its employees are not responsible for any pre-existing injury or recurrence of any undisclosed pre-existing injury or illness of the above camper prior to the first day the camper registers.
Parent/Guardian Signature

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Date

Month Day Year
Date
Emergency Phone Number
Select Payment Method

Credit Card Mail Check/Cash Bring Payment First Day of Camp

Checks should be made payable and mailed to:

Comets Athletic Booster Club

600 S. Fayetteville St.

Clayton, NC 27520
Any questions, please contact Coach Everson Simmons:

eversonsimmons@johnston.k12.nc.us
Should be Empty:

COMET BOY'S BASKETBALL CAMP

PARENT AND MEDICAL CONSENT / RELEASE

Credit Card