Printable Sign Up Form
If you prefer to pay via postal mail you may print out this form and send it in with a check or credit card # to the following address:
Nick Nurse
109 Carver Ave.
Rhodes, IA 50234
Parent's Release and Indemnity Agreement to
Nick Nurse Enterprises Basketball Camps
In consideration of the acceptance of this application for enrollment in any of the Nick Nurse Enterprises
Basketball Camps, I/we, intending to be legally bound, hereby for myself, my heirs, executors and
administrators, waive and release any and all rights and claims for damages I may have against
Nick Nurse Enterprises Basketball Camps, all sponsors and all employees and agents of Nick Nurse
Enterprises Basketball Camps for any or all damages which may be sustained and suffered by me in
connection with my/our association with, or entry into this camp, and which may arise out of
my traveling to, participating in or returning from the camp.
I/We hereby grant permission for my/our child to be a participant in the specified Nick Nurse Enterprises
Basketball Camp and if an injury should occur during, traveling to or returning from the camp, I/we agree
to pay for all costs, present and future, through my/our medical insurance policy and/or personal finances.
We also agree that the use of photography is permitted and may be used in any way by Nick Nurse Enterprises
for promotional purposes.
Parent/Guardian Signature_____________________________ Date____________________
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In the event that you are not accepted into this academy, your payment will be refunded.
Academy Date________________
Name _____________________________________________________
Address ____________________________________________________
City, State __________________________________________________________________
Zip ____________________________________________________
Phone _____________________________
Email ________________________________________
Check enclosed____ OR Credit Card___
Credit Card # ____________________________ Exp. _________
Signature _____________________________________
Please write one paragraph that explains:
"WHY I should be considered for this Academy and what is my playing experience”
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Important: To ensure the greatest chance of being accepted as a new member - make sure you submit this form in IMMEDIATELY.
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