Minnesota Elite Basketball Camp

2010 Minnesota Elite Girls Basketball Camp:

June 28-30 @ Concordia University-St. Paul

Insurance Form

*Heart Disease
Yes
No
*Family History of Heart Disease
Yes
No
*Recurrent Illness
Yes
No
*Allergies
Yes
No
*Asthma
Yes
No
*Epileptic
Yes
No
*Mononucleosis
Yes
No
*Absense of Paired Organ
Yes
No
*Head Injury
Yes
No
*Neck Injury
Yes
No
*Unconsicious
Yes
No
*Taking Prescribed Meds
Yes
No
*Shoulder Dislocation
Yes
No
*Shoulder Seperation
Yes
No
*Low Back Injury
Yes
No
*Knee Injury
Yes
No
*Thigh Injury
Yes
No
*Ankle Injury
Yes
No
*Fractures
Yes
No
*Muscle Pulls
Yes
No
*Surgery
Yes
No
*Wear Visual Aids
Yes
No
*Wear Dental Appliance
Yes
No