L&C Start Smart Basketball Camp

Name

First NameLast Name

Grade Going In To Fall of 2026

Address

Parent/Guardian Name

Parent Phone

Player Phone if applicable

Parent Email

Emergency Contact Name

Emergency Contact Phone

Medical Information/Allergies we should know about

Waiver:

I hereby authorize the directors of the Start Smart Lewis & Clark Basketball Camp to act for me in their best judgement in any emergency requiring medical attention and I hereby waive and release the camp, its staff and Plaza Public School from any and all liablity for any injuries or illnesses incurred while at camp.

Signature

Payment: $95-due prior to the start of camp

Venmo @Stephanie-Johnson145cash/check brought to first day of campcheck mailed to Josh Johnson 4335 65th Ave NW Plaza ND 58771