2021 Patriot Basketball Summer Camp Registration
Please complete the form below. Payment can be submitted at www.venmo.com/PatriotBasketball. If you would prefer to pay by check please bring it the first day of camp. If you have any other questions, please email aaron@patriothoopclinics.com.

Registration is complete upon receipt of an updated physical and copy of player's immunization record emailed to aaron@patriothoopclinics.com.
Email address *
Player Name *
Player Grade (as of Fall 2021) *
Camps Attending (Check all that apply) *
Parent Name *
Parent Name (2)
Phone Number *
Phone Number (2)
Emergency Contact Name and Number (not listed above) *
Please describe any medical alerts for your child *
By checking this box, I allow Patriot Basketball to seek medical treatment for my child in the event of an emergency. Every attempt will be made to reach parents if a situation arises. *
By checking this box, I hereby give my permission for the above registrant to participate in a basketball clinic run by Patriot Basketball, Inc. I understand that participation in Patriot Basketball, Inc. clinics by the child listed above involves a certain degree of risk that could result in injury, death or loss or damage to a person or property. After carefully considering the risk involved, I hereby release, hold-harmless and waive all claims associated with this activity that I may have against Patriot Basketball, Inc., its employees, officers, directors, agents, volunteers and members. *
A copy of your responses will be emailed to the address you provided.
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