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) *
Required
Camps Attending (Check all that apply) *
Required
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. *
Required
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Patriot Basketball, Inc.. Report Abuse