Registration

REGISTRATION FORM: Summer Basketball Camp

Baller's Name

Birth Date

Age

Grade

Address

City

Zip

How did you hear about the program?

Uniform Size

Parent/Guardian Name

Home Phone

Cell Phone

Parent/Guardian Name

Home Phone

Cell Phone

Address (if different from above)

City

Zip

EMERGENCY INFORMATION

Emergency Contact

Home Phone

Work Phone

Cell Phone

Relationship to Baller

Insurance Company

Insurance Plan/Group Number

Desired Medical Facility

Physician to Contact

Allergies and Medical Restrictions

Half Day: $125.00
Full Day: $175.00
At the Door: $200.00

No Refund Policy: The fees and monies raised for this program are non-refundable. If for any reason a participant quits or is released from the program, there will be no refund of any participation fees for this skills camp.