Bobby Madison Basketball Camp 2023-LATE REGISTRATION

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Dates: Monday, June 19-Thursday, June 22, 2023

COLUMBIANA MIDDLE SCHOOL
8 a.m.-12 noon
Ages 6-12
Registration fee: $75 per camper (Additional sibling, $60)

Late registration fee (after June 7): $90

Email *

Camper's Last Name *

Camper's First Name *

Camper's Age as of 6/16/23 *

Camper's T-Shirt Size *

Physical Address (Street Number, City, State, Zip Code) *

Mailing Address (if different from physical)

Parent(s)'/Guardian(s)' Name *

Contact Phone Number *

Emergency Contact Name (In the case parent/guardian cannot be reached) *

Emergency Contact Phone Number *

Is the camper covered under an insurance policy? *

Yes

Please read carefully: I affirm that I am fully aware of my (my child's) physical condition and I fully realize the dangers of participating and voluntarily assume the risks associated with my participation in Bobby Madison Basketball Camp. With this knowledge, I release forever Shelby County High School, Bobby Madison and any other agents, coaches or participants responsible for any damages or injuries incurred while participating in this camp. I have carefully read this form and fully understand its contents. I am aware that this is a release of liability, and an agreement between myself, Shelby County High School, Bobby Madison and for the benefit of others described herein. I sign it on my own free will. *

Agree

By submitting this form, I agree to remit payment of $75 per camper ($60 per additional SIBLING) to Bobby Madison Basketball within 48 hours. I further understand that if payment is not received or postmarked within the 48 hours after submission of this form, my registration is deemed incomplete and my camper cannot be guaranteed a spot for the 2023 Bobby Madison Basketball Camp. *

Cash or Check payable to Bobby Madison mailed to P.O. Box 1603, Columbiana, AL 35051

Venmo: @BobbyMadisonBasketball (include camper's name)

Name of individual completing this form/Relationship to registered camper *

Send me a copy of my responses.

Submit

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