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Basketball Summer Camp Registration
Event Timing: June 10 - 13, 2019, 1 :00 - 4:00 p.m., Ages 6 - 16
Event Address: 710 South Sunrise Way, Palm Springs, Desert Chapel High School Gymnasium
Contact us at (760) 660-3372 or admin@campofchamps.info
Email address *
Player Information
Player Name *
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Player Age *
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Player Address *
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City, State, & Zip Code *
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Player Phone Number *
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Player Cell Number *
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Player Email Address *
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Parent/Guardian Contact Information
Parent/Guardian Name *
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Parent/Guardian Address *
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Parent/Guardian City, State, & Zip Code *
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Parent/Guardian Phone Number *
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Parent/Guardian Cell Number *
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Parent/Guardian Email *
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Method of Payment ($150) *
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I understand that I will have to pay on the first day of registration (June 10th ) (Credit card payments can be processed over the telephone ahead of time) *
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Accident Waiver & Release of Liability Form
I hereby assume all of the risks of participating in these Basketball Camps, including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault.

I certify that I am physically fit and have not been advised to not participate by a qualified medical professional. I certify that there are not health-related reasons or problems, which preclude my participation in these Basketball Camps. I acknowledge that this Accident Waiver and Release of Liability Form will be used by the organizers of the Basketball Camps, in which I may participate, and that it will govern my actions and responsibilities at said Basketball Camps.

In consideration of my application and permitting me to participate in these Basketball Camps, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows:

A) WAIVE, RELEASE, AND DISCHARGE from any and all liability but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from these Basketball Camps. The following entities or persons: Camp of Champions A & M, Desert Chapel School, Timothy Ingram, and/or their coaches, agents, representatives, or volunteers.

B) I INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in these Basketball Camps, whether caused by negligence or otherwise.

I acknowledge that these Basketball Camps may carry with it the potential for death, serious injury, and personal loss. The risks may include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of participants, equipment, vehicular traffic, actions of other people including, but not limited to, participants, volunteers, spectators, coaches, and lack of hydration.

I consent and agree that Camp of Champions A & M, Inc., and/or their coaches, agents, representatives, or volunteers may take photographs or digital recordings of me as a participant during the Basketball Camps and use these in any and all media for training and promotional purposes. I further consent that my identity may be revealed therein or by description text or commentary. I waive any rights, claims, or interest and I understand that there will be no financial remuneration.

The Accident Waiver, Release of Liability, and Image Release shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.

I CERTIFY THAT I HAVE READ THIS DOCUMENT, AND FULLY UNDERSTAND ITS CONTENTS. I am aware that this is a Release of Liability and a contract and I sign it on my own free will.

Player Signature & Date *
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Parent/Guardian Signature & Date *
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Parent/Guardian Waiver for Minors (Under 18 years of age)
The undersigned parent and/or natural guardian does hereby represent that he/she is, in fact, acting in such capacity, has consented to his/her child or ward's participation in the Basketball Camps, and has agreed individually and on behalf of the child or ward, to the terms of the Accident Waiver and Release of Liability set forth above. The undersigned parent or guardian further agrees to save and hold harmless and indemnify each and all parties referred to above from all liability, loss, cost, claim, or damage whatsoever which may be imposed upon said parties because of any defect or lack of such capacity to so act and release said parties on behalf of the minor and the parents or legal guardian.
Parent/Guardian Signature & Date *
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