Kay Yow Application

2008 Kay Yow Basketball Camp Scholarship Contest Application Please print application and mail to: Haywood EMC 1560 Asheville Road Waynesville, NC 28786 Attn: Ken Thomas
Name:
Address:		City:
County:	Zip:	School:
Phone:	Age:	Date Of Birth:
Parent's or Guardian's Name:
Guidance Counselor's Name:		P.E. Teacher's Name
Scholastic Information (use additional pages if needed)
Academic and school honors received:



Extracurricular Activities (use additional pages if needed)
Involvement in sports or other school activities:



Community, civic and church activities:


Hobbies, interests and talents:

Student Name:____________________________________________________

Parental/Guardian Consent:

I do hereby allow my child to attend the Kay Yow Basketball Camp, should she be chosen as a Touchstone Energy camper.
I do hereby commit to provide transportation for my child to and from the Kay Yow Basketball Camp, located in Chapel Hill, NC on June 22-26, 2008, should my child be selected as a Touchstone Energy camper.
I have checked our family’s calendar and know that should my child win this scholarship, he will be available to attend the camp on June 22-26, 2008.
I understand that if my child cannot meet these commitments, she will not be eligible for the scholarship.
The Kay Yow Basketball Camp requires that campers be able to safely participate in camp activities, and that children with medical or mental conditions that interfere with safe participation are not eligible to attend. I will familiarize myself with the medical requirements stated in the camp application materials, and certify by my application that my child is physically and mentally able to safely participate in the camp.
I understand that available health care services at the camp do not include on-site care by a physician. Registered nurses and athletic trainers are on duty to oversee MINOR MEDICAL CONDITIONS only. The Camp cannot accept students who cannot take part in normal camp routine and activities.
I understand that the Kay Yow Basketball Camp management has right of refusal for any camper based on the above conditions and has the ability to terminate a camper’s time at the camp due to an infraction of camp rules.

_______________________________________________________________

(Parent/Guardian signature)

Questions?
Call Ken Thomas or Stacey Messer at 828-452-2281or 800-951-6088.

Haywood Electric Membership Corporation is located in Waynesville, with a district office at Lake Toxaway, North Carolina. We provide power to over 25,000 electric services.