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PUSH Basketball Camp Registration
July 28th - August 1st, 2025
9:00 am - 2:00 pm (Drop off begins at 8:45 am)
$200 per camper
Campers will need to bring their own lunch. Concessions will be available for drinks and snacks.
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Parent Name
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Parent E-Mail Address
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Parent Phone Number
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Parent Home Address
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Camper First Name
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Camper Last Name
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Camper's Age
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Camper's Shirt Size
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Youth Small
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Youth Large
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Health Insurance Company
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Health Insurance Policy Number
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Emergency Contact First & Last Name
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Emergency Contact Phone Number
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Waiver
By registering my child for the PUSH Basketball Academy Basketball Camp, I hereby grant approval for my child to take part in the PUSH Basketball Academy Basketball Camp at Dr. Phillips High School. I confirm that my child is in good health and capable of participating in all camp activities without any limitations. In the event of a medical emergency and if I am not present or cannot be reached, I authorize the procurement of necessary medical attention. Furthermore, I release Ben Witherspoon, Daryl Dorsey, PUSH Basketball Academy, Dr. Phillips High School, Orange County Public Schools, and all camp volunteers from any liabilities related to injury or illness.
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I have read the waiver above and agree to the terms.
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Digital Signature
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Date
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Payment Links
Please include camper's name in payment description
Venmo: Click here or send to 954-937-4451
Zelle: Click here or send to 954-937-4451
CashApp: Click here or send to $heycoachben
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