Women's Basketball Camp

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Email address *

First name *

Last name *

Address 1 *

Address 2

City *

State *

ZIP Code *

Cell Phone Number *

Grade

T-shirt size

You must register by Monday, May 27 to receive a t-shirt

We (or I) hereby request that you accept the application of for the 2024 MCC Women’s Basketball Camp during the dates set forth in this application and in consideration of your acceptance of this application, we (or I) as the parents or guardians of our (or my) child/ward hereby release the Marshalltown Community College, the Athletic Department and all their employees and agents from all claims on my account of any injuries which may be sustained by our (or my) child/ward while attending the Camp. We (or I) further agree to hold the MCC and all their employees and agents harmless from any or all claims made against them on account of our (or my) child’s/ward’s participation in the MCC Women’s Basketball Camp. We (or I) also give you our (or my) permission to act in your best judgment in treating any injury that our (or my) child/ward may sustain during the camp.

Parent/Guardian's Name *

Date *

Medical Insurance Carrier *

Policy # *

This form is to sign up for the MCC Women's Basketball Camp. Payment can be mailed to Attn: Dylan Longley, MCC Women’s Basketball • 3700 S. Center St. • Marshalltown, IA 50158 or at the front door. Checks should be payable to IVCCD.

We look forward to seeing you.

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