Lions News · May 2 Legacy Early College Basketball Camp Online Sign-Up You may now register and pay for LEC Basketball Camp online. Dates for camp are June 10-13, 2019. Legacy Early College Youth Basketball Camp Please complete this form accurately, with payment to have your child/children registered for the Legacy Early College Basketball Camp. Parent/Guardian Name* First Last Date* How many children will attend the camp?*123Athlete's/Child's Name* First Last 2nd Athlete's/Child's Name (If Applicable) First Last 3rd Athlete's/Child's Name (If Applicable) First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Best phone number to be reached at?*Best Email to be to be reached at?* Name of Emergency Contact 1* First Last Phone Number of Emergency Contact 1*Name of Emergency Contact 2* First Last Phone Number of Emergency Contact 2*Medical Waiver*I hereby state my child is in good health and has my permission to participate in all Legacy Youth Basketball Camp activities. I authorize the staff at the camp to provide emergency first aid in the event of sickness or injury. I also give permission for the camp staff to sign for me in the event that emergency treatment, hospitalization, and/or surgery is required. I understand I am financially responsible for any medical bills incurred by my child while at the Legacy Early College Basketball Camp. My acknowledgement below hereby releases the camp, Legacy Early College, and staff from any and all liability and any manner of actions, suits, damages, claims, and demands on the account of personal injury arising from my child's participation. (Please state your name and initials as your electronic signature)Does your child/children have any medical conditions or allergies that camp staff needs to be aware?*Does your child/children have any prescribed medications that they must take during camp hours?*Health Insurance Provider (If Applicable)What size t-shirt does your child wear?*SmallMediumLargeX-LargeXX-LargeWhat size t-shirt does your second child wear? (If Applicable)SmallMediumLargeX-LargeXX-LargeWhat size t-shirt does your third child wear? (If Applicable)SmallMediumLargeX-LargeXX-LargeAthlete/Child 1* Price: $90.00 Quantity: First camper is $90.00Additional Siblings Attending Camp Price: $80.00 Quantity: Price for first camper's siblings are $80.00 each.Early Drop Off Camper Price: $10.00 Quantity: Early Drop-off time begins at: 8:00 AM Cut-off for Late Pick-Up: 5:00 PM Early drop off is 10.00 PER camper. Late Pick-Up Price: $10.00 Quantity: Late Pick-Up for campers ends at 5:00 PM. Late Pick-Up is $10.00 PER Camper. This is a separate cost from Early Pick-Up. Total $0.00 Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name *If you are not paying with credit card, we only accept cash, money orders, or cashier checks in person. Please make money orders payable to Legacy Basketball. WE DO NOT ACCEPT PERSONAL CHECKS.