Texas Prep Basketball School
                               Registration Form  2010
                                   (print and mail form)
                                                
Send registration form to:  
                                            
Texas Prep Basketball School                      
c/o Shera Starnes                                         
200 Osage Ct.                                                       
Georgetown, TX 78626                                            

Camp Tuition:        $350.00  Checks payable to:  Texas Prep Basketball School
            
(please print).  
Last Name:                                        First Name:                                            

Address:                                                                                                                

City:                                                 State:                         Zip:                        

Phone:                                         Alt phone:                                                   

Height:          Weight:           Age:                Sex:______Grade 2010-11:                         

School (name/city):                                                                                         

valid email address:                                                                                       

Roommate preference: (optional)                                                                 

I hereby authorize the Directors of Texas Prep Basketball School to act for
me according to their best judgement in any emergency requiring medical
attention and I hereby waive and release Texas Prep Basketball School
from any and all liability.

                                                                                                                   
Parent or Guardian Signature                                Camper signature

Insurance Information:

                                                                                                                   
Medical Insurance Company                                Policy holder’s name

                           
Policy and Group #