2019 CAMP PRINT APPLICATION

RESIDENTIAL AND DAY CAMP COSTS

  

CAMP SESSIONS:  1 BIG WEEK INSTRUCTIONAL CAMP  (Check Box on printed form)

Boys Overnight Residential  Camp-St Olaf                          OVERNIGHT COSTS:
Sunday thru Thursday                                                     $490 per camper  ______

  _____  July 14-18                                                                 $475 per camper (5 or more 

                                                                                                 mailed together) _______

                                                                                              $465 per camper for team (10 or more)_______

DEPOSIT: $ 225 Deposit required with application  (Fee includes room, meals, and

 partial medical insurance).                                
                                                                                                                                       

Day Campers : $380 Day Campers -Includes lunch & dinner.___________
 
              ******   Returning Camper ______RETURNING CAMPER  $10 DISCOUNT

PRINT 2019 Camp Koz Application Form

scan and email: kosmoski@stolaf.edu or mail: 13040 Hamburg Court, Apple Valley MN. 55124 website:www.coachkozbasketballcamp.com Office: 507-786-3252 Coach Koz:507-304-1831

We are looking forward to having your son at camp this summer!

  

Parental Consent: I hereby grant permission for my son to attend the 2019 Coach Koz Fundamental Basketball Camp Inc. and to act for me according to their best judgment in any emergency requiring medical attention and hereby waive and release the from any all liability for any injuries incurred while at camp.                                                                                                     Parent/ Guardian's Signature________________________________________  Date  __________


  

Coach Dan Kosmoski Fundamental Basketball Camp Inc

13040 Hamburg Court, Apple Valley, MN.55124

507-304-1831

Doctor's Statement of Health (present at Registration)

  

  • Doctor’s Statement of Health or copy of School or Athletic Physical. 
  •  Print and Bring to REGISTRATION on Sunday, July14.)

 


I HAVE EXAMINED ___________________________AND FOUND HIM TO BE HEALTHY AND ABLE TO COMPETE IN BASKETBALL AND GENERAL RECREATIONAL ACTIVITIES (OF HIS CHOOSING) DURING THE 2019 COACH KOZ FUNDAMENTAL BASKETBALL CAMP, INC.
 

PLEASE LIST ANY ALLERGIES TO MEDICATIONS:____________________________________________
LAST TETANUS SHOT__________________________________________________________________________
PERTINENT INFORMATION (DIABETES, EPILEPTIC, PREVIOUS FRACTURES, ETC)__________________________________________________________________________________________
DATE EXAMINED:_____________________________

PHYSICIAN'S SIGNATURE:___________________________
                    Present doctor's statement at Registration or School or Athletic Physical.