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Straight Shooters Chapelgate Lower School Camp

When: June 22- June 24, 10 am to 2 pm

Where: Chapelgate Christian Academy, 2600 Olive Branch Way, Marriottsville, MD 21104

Who: Boys and girls rising 1st through rising 5th graders

Cost: $175

Payment options:  Payable to Straight Shooters Basketball-  Zelle,  Paypal, Venmo, check, or cash

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Email *
Student First Name *
Student Last Name *
Student Date of Birth *
Student Grade *
Parent Email *
Student Address *
Parent Or Legal Guardian 1 *
Emergency Contact Phone number 1 *
Parent Or Legal Guardian 2 *
Emergency Contact Phone number 1 *
Primary Care or Physician  *
Primary Care or Physician Phone Number *
Are there any health problems including physical, psychiatric, or behavioral of which need to be aware?  *
Are there any medications, dietary restrictions, allergies, or special needs that we need to be aware of?  *
I understand that, as a condition of admittance, as a partcipant, the undersigned, on behalf of all parents and guardians, and on behalf of the applicant, hereby releases Straight Shooters Basketball and all other employees or agents of the club from any and all liability from injury or illness, mental or physical, suffered by the participant during or related to the club, unless caused by a willful act or gross negligence by the person or entity against whom the claim is made.

Please enter your full name below as agreement of above paragraph.
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I give permission for photos to be taken of my child at club.

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Venmo directly to Straight Shooters 
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