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Eden Middle School Girls (5th-8th) Summer Basketball Camp Registration
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Student Last Name *
Student First Name *
Grade entering in Fall of next school year *
Parent's name *
Primary email contact *
Secondary email contact
Primary phone number *
Secondary phone number
Campus *
T-shirt size *
MEDICAL TREATMENT RELEASE: FOR USE IN CASE OF AN INJURY REQUIRING IMMEDIATE MEDICAL ATTENTION!
In the event that I/We are not present, or quickly available, I hereby consent to, and request medical treatment such as would be in the best interest of my child(ren).
I also release from liability the Eden Christian Academy representative(s) and proper medical staff in attendance.
I understand this release generally applies to concerns, which involve, but are not limited to, injuries such as broken or dislocated bones, potential damage to vision, or other serious injury, which would NOT qualify under a hospital’s policy requiring a life threatening injury.
I also list my family doctor or doctor of choice in  the event additional records or information is needed.
Please check: *
Required

Cost: $100 per registrant.  Includes an ECA Summer Camp Shirt if registered by 5/26/23

Method of Payment: 

FACTS accounts will be charged for any enrolled registrant. 

If you are not an Eden family or do not have a current FACTS account, please make checks payable to Eden Christian Academy. 

On memo line: ms bball camp 

Mail to:

 Eden Christian Academy

 ATTN: Greg Foltz

 318 Nicholson Road,

Sewickley, Pa 15143

Doctor's name *
Doctor's phone *
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