Parent InformationQuestions - Email: ddoyle@internationalsport.org or Call 860-233-3500 x2296


2010 KO Skills Development Basketball Clinic

Medical Form

Please complete form or download here.

Name of camper:

Height:           Weight:           Age:
 
IMPORTANT: IN CASE OF EMERGENCY

Emergency phone number(s) to reach parent(s) during day:

Home: Work:
Home: Work:

Physician name:
Physician phone:

Does your child have any health problems or allergies that will effect their participation?
Please List:

Is your child presently taking any medication?

Name of family insurance carrier:
Policy #

WAIVER AND RELEASE

I hereby authorize the directors and/or any member of the staff to obtain and/or provide emergency medical treatment for my child in my absence and according to their best judgment.  I further commit to pay all costs for any medical care given.  I also understand that, in the case of a medical emergency involving my child, the Camp staff will do their best to contact me.   I hold Kingswood Oxford School, the directors of Camp Renaissance/KO Skills and its staff members harmless should any injury occur to my child.

I Authorize

The KO Skills Development Basketball Clinic Form must be returned by no later than July 19.
Please return to: Dan Doyle, c/o Kingswood Oxford School, 170 Kingswood Road, West Hartford, CT 06119
Camp Renaissance|HS Basketball Clinic|Basketball Clinic Ages 5-14
Basketball Skills Development Program
Application Information for CITs/Counselors|Dan Doyle's Personal Camp Philosophy/16 Camp Objectives