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2025 Hudson Falls Rec Basketball Summer Camp

Dates: July 7th - July 11th
Location: Primary School Gymnasium

Session 1: Grades 1st-3rd (11:00-1:00pm)
Session 2: Grades 4th-6th (1:00-3:00pm)

Athletic apparel, sneakers and Water bottle recommended. 

A confirmation email will be sent to the email address provided with your sign up information.
If you are signing up more than one child, please complete this form separately for each one.

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Email *
Session Choice: *
Name of participant *
Date of Birth
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Home Address: *
Name of parent/guardian *
Parent/Guardian Phone Number: *
Authorized Pick up and Emergency Contact Information: Contact #1:
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Emergency Contact #1 phone number:
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Contact #2 Name and phone number
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Family Physician:
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Physician's Phone Number:
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In the event of a medical emergency, I give permission for  __________________________________________to receive emergency medical transportation and treatment at the nearest medical facility. By adding your child's name below you are granting permission for the services above.
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  MEDICAL INSURANCE PROVIDER/COMPANY"
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INSURANCE I.D.#
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PARENT/GUARDIAN e-SIGNATURE
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Date
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Does your child have any of the following medical diagnosis and if “yes” do they require any Medication?
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Required
If you answered answered yes to any of the conditions above please explain treatment and other helpful info. If there are any other special considerations that we should be aware of please state those below as well. Example: medicine names, other allergies etc...
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By electronically signing and dating below (Parent/Legal Guardian) you hereby give (child) permission to attend the Hudson Falls Central School District Recreation program. Furthermore, I understand the Hudson Falls Central School District Recreation Department may photograph or videotape the events or activity in which my child is participating.  I give permission for the Recreation Dept. to use photographs or videotape of me and my child for the purpose of promoting the Hudson Falls Central School District Recreation on Flyers and/or Website.  I give permission with the following understanding: No compensation of any kind will be paid to me (or my child) at this time or in the future for the use of my or my child’s likeness. By signing below, I hereby acknowledge and accept the above statements.                                                      
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Permission: I/We understand that the questions are asked in order to decide if this student is in proper condition to participate in the athletic activity named at the top of this form. The answers are correct as of the date this form is signed. All answers will be kept confidential in your child's health record in the school health office.                                                                                  By adding your name this is your verified electronic signature: *
A copy of your responses will be emailed to the address you provided.
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