Please use one form per family to get signed up.

1. One-Day Basketball Camp For all 1st thru 6thgrade boys and girls Saturday, August 16 from 8am-4pm Rolling Ridge Elementary School Gym Cost: $25 Space is limited! Don’t delay! BRING A FRIEND! Featuring: Individual Skills Teaching - Character Building Messages - Ball Handling, - Shot Techniques, - Speed drills – Micro-team Scrimmages – and lots of fun!!! One-day basketball camp is sponsored by Christian Fellowship Church Local Outreach Department in partnership with Rolling Ridge Elementary School and the CFC Men’s Basketball League. www.cfellowshipc.org/local Questions? – Please contact Mike Trivett, Director of Local Outreach, Christian Fellowship Church at mtrivett@cfellowshipc.org or 703-724-4907. www.cfellowshipc.org/local Participants must be entering 1st thru 6thgrade children (Fall 2014). Camp will go from 8am-4pm on Saturday, August 16th[breakfast will be served at 7:30am] Cost $25.00 per child (which includes, skill-building drills, t-shirt, breakfast, snack, and lunch.) (Financial Assistance is available upon request) Multiple same family member discount is available and goes as follows: 1stcamper: $25; 2nd camper: $15; 3rdcamper: $10; 4th camper: Free. Each participant will receive quality basketball skill-building, a camp t-shirt, breakfast, snack, and lunch. Parents are invited to attend the closing ceremony at 3:15pm (time subject to change). Please use one form per family to get signed up. Send or bring your registration form along with payment by no later than Wednesday, August 6th! Make checks payable to “CFC” and write in the memo “BBALL CAMP” TO: Christian Fellowship Church - 21673 Beaumeade Circle Ashburn, VA 20147 (Attention: RR Basketball Camp or Mike Trivett) Name of Child: __________________________ Age: _____ Grade Entering this Fall 2014: (Circle one) 1st2nd 3rd 4th5th 6th Shirt Size (Circle One): YS YM YL YXL AM AL AXLStreet Address: _________________________ City: _________________ Zip Code: _________ Gender: __ M __ FName of Parents/Guardian: ______________________________________ Email Address: _________________________Home Phone: _________________ Cell Phone: __________________ School enrolled in for the Fall 2014: ______________________________________ Allergies (including food) or other conditions which may limit activity: ____________________________________________ **Please note: If allergy is very severe your child will need to bring their own snacks and lunch. Any Medical Conditions of the child listed above: _____________________________________________________________ Any Medications the child is currently taking on a regular basis: __________________________ Camp Waiver: I understand that in signing this form, I release and hold harmless Rolling Ridge Elementary School and Christian Fellowship Church, its trustees, officers, employees, Camp Directors and staff, and any volunteers from any liability, past or future, fully and completely. I authorize your employees, volunteers, executive staff and/or designated medical professionals to administer emergency medical assistance. Parents/Guardian Signature: ______________ Date: _____________ Basketball • Please use this section for any additional children you are registering of the same family: • Child’s Name: _____________________ Age: _____ Gender: __ M __ F Shirt Size(Circle One): YS YM YL YXL AM AL AXL • Grade Entering this Fall 2014: Circle one) 1st 2nd 3rd 4th 5th6th • Allergies (including food) or other conditions which may limit activity: ____________________________________________

2. Campamentode Baloncesto Para todos los niños y niñas del 1 al 6 grado Sábado, Agosto 16 de 8am-4pm Rolling Ridge Elementary Gimnasio Costo: $25 Espaciolimitado! No se demore! TRAIGA A UN AMIGO! presentando: - técnicas individuales- crear carácter-manejo de pelota – técnicas de tiro, - practica de velocidad – practicas en equipo – y mucha diversión!!! Campamento de un día de baloncesto es auspiciado por Christian FellowshipChurch Local Outreach Department con asociación con la Escuela de Rolling Ridge y la Liga de Baloncesto Masculino de CFC . www.cfellowshipc.org/local Preguntas? – Por favor contactarse con Mike Trivett, Director de Local Outreach, Christian Fellowship Church al mtrivett@cfellowshipc.orgor 703-724-4907. Participantes deben estar entrando al 1er a 6to grado (otoño 2014). Campamento será de 8am a 4pm el sábado, 16 de agosto. [Serviremos desayuno a las 7:30am] Costo $25.00 por niño (incluye , practicas y técnicas, camiseta, desayuno, merienda, y almuerzo.) (Asistencia económica esta disponible bajo petición) Hay descuento familiar (hermanos) y es la siguiente: 1er niño: $25; 2do niño: $15; 3erniño: $10; 4to niño: gratis. Cada participante recibirá técnicas de baloncesto, una camiseta del campamento, desayuno, merienda y almuerzo. Los padres están invitados a asistir a la ceremonia de clausura a las 3:15 (hora sujeta a cambios). Utilice un formulario por familia para inscribirse. Enviar o traer su formulario de inscripción junto con el pago no más tarde del miercoles, 6de agosto! Haga cheques a nombre de “CFC” e incluya en el memo “BBALL CAMP” A: Christian FellowshipChurch - 21673 BeaumeadeCircle - Ashburn, VA 20147 (Attention: RR Basketball Camp o Mike Trivett) Nombre de niño: ______________________ Edad: _______ Grado en este Otoño 2014: (Marque uno) 1st2nd 3rd 4th5th6th Talla (Marque uno): YS YM YL YXL AM AL AXLDirección: ___________________________ Ciudad: ________________ Zip code: _______ Sexo: __ M __ FNombre Padre/Tutor: _______________________ Email _________________________ Telf Casa: _________________ TelfCelular: _________________ Escuela a atender en Otoño 2014: ________________ Alergias (incluya comida) u otras condiciones que limiten actividad: ______________________________________________ ** Nota: Si la alergia es muy severa su niño necesitará traer sus propios bocadillos y almuerzo. Cualquier condición médica del niño : ______________Todos los medicamentos que el niño está tomando actualmente de forma regular: _______________ Renuncia de campamento: Entiendo que al firmar este formulario, absuelvo de sostener culpable a Rolling Ridge Elementary y Christian FellowshipChurch, su Patronato, oficiales, empleados, directores de campamentos y personal y los voluntarios de cualquier responsabilidad, pasado o futuro, totalmente y completamente. Autorizo a sus empleados, voluntarios, personal ejecutivo y/o designado profesionales médicos de administrar asistencia médica en caso de emergencia. Firma de Padre o Tutor: ______________________ Fecha: _____________  Baloncesto • Utilice esta sección para inscribir niños adicionales que se registran bajo la misma familia: • Nombre de niño: ____________________Edad: _____ Grado en este Otoño 2014: (Marque uno) 1st 2nd 3rd 4th 5th 6th • Talla (Marque uno): YS YM YL YXL AM AL AXL • Alergias (incluya comida) u otras condiciones que limiten actividad:_______________________________________________