2021 Twin Lakes
Boys Basketball Camp
WHEN: June 2nd – 4th (Wed - Fri)
TIMES: 8:30am-10:30am Grades Kindergarten & 1 (Next Year) st
8:30am-10:30am Grades 2 & 3 (Next Year) nd rd
8:30am-12:00pm Grades 4 , 5 , 6 , 7 (Next Year)
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Registration and check in starts at 8am on Wednesday at each location.
WHERE: Kindergarten & 1 Grade st
Junior High Back Gym (air conditioned)
2 & 3 Grade
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Junior High Main Gym
4 – 7 Grade
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High School gym (air conditioned)
COST: $40.00 Grades Kindergarten through 3 rd
$60.00 Grades 4 through 7
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**If you have more than one child in the same family, the second child will be half the price of the
lowest amount.
Total may be mailed in, or send a $25.00 non-refundable deposit, with the remaining amount
due on the first day of camp (June). Make checks payable to Mtn. Home Basketball Camp.
If you mail your form in, please mail it by May 24th. Early registration is greatly appreciated!
Send Application and Deposit To:
Josh Fulcher
Camp Director
500 Bomber Blvd.
Mtn. Home, AR 72653
*Registration will begin at 7:15am for 4 -7 .
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*Registration will begin at 7:45am for K-3 . rd
*A concession stand will be available during break times.
_ _ _ _ _ _ _ (Keep top portion for your information. Mail or bring the bottom portion.)_ _ _ _ _
NAME __________________________ SCHOOL ______________________________
ADDRESS _________________________________________________________________
PHONE NUMBER (Home) _______________________ (Work)_____________________
Grade (Next Year) ___________
T-Shirt Size: (Children Sizes:) (Adult Sizes:)
Y-Small _____ Small _____
Y-Medium _____ Medium _____
Y-Large _____ Large _____
X-Large _____
It is our policy to secure your consent for medical treatment. In case of illness or injury, permission is granted to treat the
participant at an appropriate medical facility. By signing below you are giving your consent in advance for medical
treatment. As a parent of a participant in the camp, you hereby state that you are aware of and accept the risk inherent in the
program activity. The undersigned does hereby agree to hold harmless and indemnify the Mountain Home High staff and
coaches, Mountain Home High School, and Mountain Home School Board from any and all liability, loss damages, costs, or
expenses which are sustained, incurred, or required arising out of the actions of any dependent in the course of the camp.
Signature of Parent/Guardian: ____________________________________ Date: ____________________
