Application

Mail application, along with a non-refundable deposit to:

 

Basketball Camp Director

Lyon College

P.O. Box 2317

Batesville, AR 72503

Make checks payable to Lyon College


Please Check One

   June 2-5 - Elementary Boys & Girls Day Camper ($75 Non-Resident)

   June 8-11 - Junior and Senior Boys Camp ($235 resident camper, $135 Commuter)

   June 7 - Girls Shooting Camp ($60 Non-Resident)

   June 29-July 2 - Junior and Senior Girls Camp ($235 resident camper, $135 Commuter)

Deposit Enclosed (please check one)

   $25.00 Elementary Boys and Girls Day Camper

   $50.00 Junior and Senior High Resident Camper

   $50.00 Commuter Camper (non-resident)

   $50.00 Girls Shooting Camper

 

*****Please Print*****

Name__________________________________________________

Address________________________________________________

City & State_____________________________________________

Zip_______________

Telephone: (Home)________________________________________

        (Emergency)_________________________________________

Grade (next year)_______________________

Height___________   Position (circle one)      G        F        C

T-Shirt Size (circle one)      S        M        L        XL

School_________________________________________________

Parents_________________________________________________

Roommate     1) __________________________________________                  

PARENTAL CONSENT FORM

The undersigned, being a parent or legal guardian of the child requesting camp admittance, does hereby affirm that the applicant is in good health, and suffers from no illness, disability or condition that requires the taking of medication on a regular basis unless that condition is disclosed and approved. Furthermore, the undersigned has no knowledge of any reason the applicant cannot participate in vigorous physical activity.

The undersigned hereby expressly agrees to be responsible for any medical bills incurred in the treatment of any illness or accident. In the event of any such accident or injury, I hereby consent to allowing any of the camp supervisors to procure any medical treatment deemed advisable on behalf of my child or ward without prior consent, recognizing that no entity involved with the Lyon Basketball Camp or Lyon College assumes responsibility for, nor do they have any liability for, the medical assistance and care selected or provided. No primary medical insurance is provided by Lyon College. I understand that, as a condition of admittance as a camper, the undersigned, on behalf of all parents and guardians, and on behalf of the applicant, hereby releases Lyon College and all other employees or agents of the camp from any and all liability from injury or illness, mental or physical, suffered by the camper during or related to camp, unless caused by willful act or gross negligence by the person or entity against whom the claim is made.

This is the _________day of ____________, 2008

Parent's Signature_______________________________________