Basketball Camp Registration

Child's First & Last Name

Does this child have any allergies?

Yes No

If there are allergies, please provide details

Child's First & Last Name

Does this child have allergies?

Yes No

If there are allergies, please provide details

Child's First & Last Name

Does this child have allergies?

Yes No

If yes, please provide details

Child's First & Last Name

Does this child have allergies?

Yes No

If yes, please provide details

Are there any special needs or medical information we should know to comfort your child? If yes, please provide a brief description and child's name.

Parent or Adult Caregivers First & Last Name

Adult Caregivers Email

This address will receive a confirmation email

Adult Caregivers Cell Phone

Full Address (include zip code)

Emergency Contact Name & relationship to camper

Emergency Contact Cell Phone

Can your child(ren) be photographed?

Yes No

* A liability and consent form will be emailed to the address provided one week prior to camp. It must be printed, signed and provided at drop off on the first day of the event in order for your child(ren) to participate. Thank you!

I agree to the following:

Event staff will call 911 in the case of an emergency and notify caregiver/emergency contact Students must be escorted to and from the front desk and signed in and out each day To print and complete the consent and liability form as mentioned in paragraph above If our plans change and my child(ren) cannot attend, I will email outreach@gsumc.net no later July 20th so that a family from the waiting list may be contacted A refund will not be available after July 6th unless a report from a doctor is provided.ption

How did you learn of this program?

Payment

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Basketball Camp Registration

Description

Please Fix the Following