2005 Bruce Pearl Tennessee Basketball Camp Application

Name ________________________________________________________________________________

Age _____________________________Grade Entering______________________________________

Address_______________________________________________________________________________

City _____________________________State__________________Zip Code_____________________

Parents' names________________________________________________________________________

Home phone __________________________________________________________________________

Parents' office or cell Phone___________________________________________________________

Person to notify if parents cannot be reached ___________________________________________

Phone _______________________________________________________________________________

Year last attended camp _______________________New Camper____________________________

Roommate Preference ___________________________Roommate's Phone___________________

Father Attending Camp _______________________________________________________________
(For Father/Son Camp only)

Please circle session and commuter/overnight:

Day/Junior Camp	June 6-9
Day/Junior Camp	July 18-21
Father/Son Camp	June 10-11	commuter	Dorm (overnight)
Team Camp	June 12-15	commuter	Dorm (overnight)
Ind. Skills Camp	June 19-23	commuter	Dorm (overnight)

Make check payable to:
UNIVERSITY OF TENNESSEE
Mail check, application and appropriate deposit to:
UT Basketball Camp Director • Thompson-Boling Arena, Room 206 • Knoxville, TN 37996

MEDICAL INFORMATION
Parent:
I, as parent of________________________________________________, age__________ expressly authorize the University of Tennessee Student Health Service, University of Tennessee Memorial Hospital and/or any other medical doctor or medical institution which might render medical treatment to my son during the period of his participation in the Bruce Pearl Tennessee Basketball Camp, to release record of said treatment to The University of Tennessee Athletic Department Trainer or its Insurance Carrier, in order that they might be better informed of my son's medical condition and capabilities while participating in the Bruce Pearl Tennessee Basketball Camp. A photostatic copy of this authorization shall be considered as effective and valid as the original.

The Health History contained in this form is correct to the best of my knowledge and the person herein described has permission to engage in all prescribed camp activities, except as noted by the examining physician and me. In the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by the Camp Trainer to hospitalize, secure proper treatment for and to order injections, anesthesia, or surgery for my child as named above.

Parent's signature______________________________Date________________Office Phone_________________Home Phone______________

Physician:
I hereby certify that I have examined____________________________and found him physically fit to attend and participate in the Bruce Pearl Tennessee Basketball Camp, and I know of no impairments, which would limit his participation in all activities in camp.

Physician___________________________Date of last tetanus immunization_________________Date examined________________

Address____________________________________Phone___________________This form must be returned and completed before camp begins.
*A photostatic copy of a physical examination form with your physician's signature within one year from the start of camp along with a parental release is also acceptable.

University of Tennessee Athletics

2005 Bruce Pearl Tennessee Basketball Camp Application

Related Videos