2026 Jason Flanigan Basketball Camp

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Camper's Name *

Parent/Guardian Name *

Camper's DOB *

Camper's Grade in School for 2026-27 *

Mailing Address *

Street, City, State, Zip

Guardian Work/Home/Cell Phone *

Email address *

Camper T-shirt size (adult)

S M L XL XXL XXXL

Camper T-shirt size (child)

S M L

I release Jason Flanigan and Holmes Community College of any and all liability from injuries. My healthcare provider will cover any injuries that may result.

Parent/Guardian Signature

Date of Signature

Mail $150 payment to Jason Flanigan at 264 Fieldstone Lane, Madison, MS 39110 once form is submitted.

For more information, contact Coach Flanigan at jflanigan@holmescc.edu or call (601) 503-7460.

* required field