Lady Bombers' Youth Basketball Camp
July 24th-27th
7:58am-Noon (Doors Open at 7:45)
Palmerton High School Gym
3525 Fireline Road, Palmerton, PA 18071
About Camp
• Improve Your Ball Handling Skills
• Increase Your Shooting Percentage through Drills and Competitions
• Enhance Your Defensive Techniques
• Learn The Bomber Basketball Team Principles for Success
• Discover Drills to do at Home
• Directed by Palmerton's High School Coaches
• Snacks and Drinks Provided
• Camp T-Shirt
• Players from other Districts are welcomed
• $80 per camper
First and Last Name
Student-Athlete's First and Last Name
Your answer
Student Athlete's nickname if available
Your answer
Parent's Name
First and Last Name of Parent(s)
Your answer
Parent's Email
Email of parents
Your answer
Parent's Phone #
Your answer
Shirt Size
Grade during 2017-2018 School Year
Payment of $80 (Due by June 14th)
To pay via paypal, click on the link. You do not need a paypal account to pay, just a credit card.
Participant Waiver & Liability Agreement
I understand that there are risks associated with playing all sports and field related activities including basketball. In consideration for the privilege to use the facility and/or attend the camp/clinic, the checkbox below indicates that I assume the risk of any injuries that the above participant may sustain while participating in any activity at the Palmerton Area School District and for any injuries the above participant may sustain while on the premises of the Palmerton Area School District. I insure that the above participant is physically and mentally able to participate in physical activities and has been examined by a licensed medical physician within one (1) year prior to attending this clinic/camp. I give permission for camp coaches or contacted health care to start preliminary treatment and arrange transportation for the above participant to a local Emergency Room in the event that the participant become(s) ill or injured. By checking the box below I am agreeing to the terms mentioned in this Waiver and Liability Agreement.
Medical Insurance Company of Parent/Gaurdain
Your answer
Policy #
Your answer
Name of Insured
Your answer
List any medical problems or issues that we need to be aware of (such as asthma)
Your answer
Emergency Contact's Name
Your answer
Emergency Contact's Phone Number
Your answer
Contact Us
Contact us at or 484-695-1001 with questions or concerns
Never submit passwords through Google Forms.
This form was created inside of Palmerton Area School District. Report Abuse - Terms of Service - Additional Terms