Camp Registration
Camp Location *
Camper Name *
Parent/Guardian Name *
Address
Email *
Phone Number
Camper Grade (Grade entering in 19-20 school year)
T-shirt Size
Emergency Contact & Phone Number *
Medical/Waiver
Camper Name and Date
In consideration of Positionless Basketball LLC acceptance of the above named player as a student in Sports camp for the period in the dates mentioned above.It is agreed that all risks attendant to watching and/or participating in camp activities including, but not limited to bodily injury, are assumed by the student and his parents and/or legal guardian and that this assumption is acknowledged, approved, and agreed to by said student and his parents and/or legal guardians as indicated by their signature hereto. I hereby grant permission for physicians, dentists, other licensed health care providers and their designees to administer outpatient medical, surgical, or dental services as appropriate, or necessary antigens or other injections, to perform emergency procedures as necessary or to refer to duly licensed medical personnel when indicated. Parent/Guardian signature below and date. I understand that this is serving as an electronic signature. *
MEDICAL CLEARANCE: I hereby certify the named camper is physically able to participate in Positionless Basketball LLC and that I know of no physical impairments which would in any manner limit his/her participation in such program. Parent/Guardian Signature and Date Below. I understand this is serving as an electronic signature. *
MEDICAL INFORMATION: Health Insurance Provider *
Policy Number
Please list any medical conditions the camp workers/volunteers should be aware of during camp.
IMAGE RELEASE: In consideration of the above named player, my minor child being allowed to participate in any way in Positionless Basketball LLC related events and activities, the undersigned agrees that such participants likeliness may be photographed or videotaped and that such image may be published in an outlet used to promote or publicize the program. Parent/Guardian Signature and Date below. I understand that this is serving as an electronic signature.
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