CAMPER INFORMATION

Camper’s Name: Male Female

Date of Birth (MM/DD/YYYY): / /

Parent’s Name:

School Level: Elementary Middle Junior Varsity Varsity H.S.

Name of School, AAU or County Team :

Street Address:

City: State: Zip:

Home Phone: - -

Cell Phone: - -

E-mail:

CAMP REGISTRATION (MARK DATES & CAMPS THAT APPLY):

Basketball Camp

Before & After Care

I would like to sign up for Before & After Care during the days that my child attends camp.

T-SHIRT SIZES (Adult Sizes):

S M L XL XXL

MEDICAL CONSENT/WAVIER OF LIABILITY:

Insurance Company:

Heath History (Check all that apply):
Asthma
Diabetes
Hay Fever
Penicillin
Seizures
Allergies
Other

None of the Above

Medications

Emergency Contact:

Phone: - - Relationship:

NOTE: Once your registration is processed, you will be contacted regarding payment and necessary forms. A signed medical waiver is required for all participants.

Click "Submit" to send this information and proceed to payment.