2022 Application Online Submission Please complete the application below. 2022 ApplicationName *FirstLastCheckboxes *MaleFemaleStreet Address, City, Zip *Parent/Guardian Name (Mother - Occupation) *Parent/Guardian Name (Father - Occupation) *Parent Email Address *Phone for Parent/Guardian *Phone for Student *Birthdate (MM/DD/YYYY) *Medical Insurance CarrierDoctor Name & Phone NumberEmergency Contact Name, Phone Number, Relationship to CamperSchool Name & School District *Grade Level *T-Shirt Size *I certify that the above statements are accurate and true to the best of my knowledge. In addition, I will follow the rules and regulations of the Ron Palmer Summer Basketball Camp/Hoop Smart at all times. If I am asked to leave the camp for behavior problems, I understand that monies are not refundable. I agree to be filmed and photographed and to use digital technology to participate in this camp. I understand that the Ron Palmer Summer Basketball Camp will strive to keep all personal information confidential. *Applicant's Name (Print)Applicant's Signature -- Date Parent or Legal Guardian's Name (Print)Parent or Legal Guardian's Signature -- DateMessageSumbit Application