L I B E R A T O R

K-4 AND 5-7 BOYS’ BASKETBALL CAMP 2017 K-7 Basketball camp for 2017 Dates and Time: K-4 May 8-10 3:15-5 PM 5-7 May 22-25 8:30-11:00 AM Location: Bolivar High School Gym Cost: $30 for K-4 and $35 for 5-7 *K-4CAMPERS CAN BE ESCORTED TO BHS WITH PARENTAL PERMISION* Enrollment form and payment can be turned into BPS, BIS, BHS or SEND INFO through e-mail/phone/text Checks Payable to: Bolivar R-1 Schools

Return to: Robby Hoegh Bolivar High School 1401 North Hwy D Bolivar, MO 65613

Attention: If bringing payment and waiver 1st day of camp, be sure to email me the below information as soon as possible!

Email: [email protected] Call or text: 573-590-6110

B A S K E T B A L L

Parent/Guardian Name:______________________________________________ Camper:___________________Graduation Year_______Grade(16-17)_____ E-Mail:________________________________________________________________ Phone Number:_______________________________________________________ Circle:

K-4 Camp ($30)

Circle: YES or NO

5-7 Camp ($35)

I want my child to be escorted to the BHS

Circle T-Shirt Size: Youth Small Adult Small

Youth Medium Adult Medium

Youth Large Adult Large

I certify that the above information is correct and that the individual listed above has my permission to participate in the Bolivar Liberator Basketball camp. Bolivar Schools, agents and representatives will not be responsible for any injuries, loss of property or any accidents during this camp. Parent Signature____________________ Date:________________ Bolivar Liberator Basketball 1960 State Champs 1962 Quarterfinalist 2008 Sectionals 2010 Quarterfinalist 2015 Final Four (4th) 2016 Sectionals 2017 Final Four (2nd)