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Little Rams Clinic


Please return to: OLPH School Office Booster Club

				505 S. Moore Rd.
				Chattanooga, TN 37421

Attention: Little Rams Clinic

Child’s name: __________________________________________________________

Child’s age and grade in school:___________________________________________

Child’s school: _________________________________________________________

Any Medical problems: __________________________________________________

Medications: ___________________________________________________________

Payment enclosed: ___ Check enclosed for $45 (make out to OLPH Booster Club) ___ Cash $45 (place in sealed envelope and send to OLPH School office and mark envelope “Little Rams Clinic”)

Shirt size: ____ Youth Small ____ Adult Small

		____ Youth Medium			____  Adult Medium
		____ Youth Large			____  Adult Large		___ Adult Extra Large

I give permission for my child to attend and participate in the Little Rams Basketball Clinic being held at OLPH School gym on February 11,18, 25 & March 3, 2012.

__________________________________ ______________________________ Parent/Guardian signature Parent/Guardian name (Print)

__________________________________________________ Parent’s cell phone and/or home phone (in case of emergency)