HAKEEM OLAJUWON ‘CITY OF BIRMINGHAM ROCKETS’ INTERNATIONAL SUMMER CAMP 2021 Registration Form

Parent or Guardian Information
Parent or Guardian *

First Name Last Name
Phone Number *

Area Code Phone Number
Emergency Information
Emergency Contact *

First Name Last Name
Phone Number *

Area Code Phone Number
Relationship *
Acknowledgment, Liability Waiver & Consent *

I, the undersigned parent/guardian of the above camper, do hereby grant the authority to the staff of the City of Birmingham Rockets Basketball Club to apply judgment in regards to medical assistance in the event of an accident, injury, or illness if they are unable to contact the parent or guardian. I authorize first aid, a medical or surgical diagnosis and treatment which may deem necessary. I, the undersigned, release the City of Birmingham Rockets Basketball Club and any of its coaches, staff, manager, and/or any parent for any responsibility in case of accident, illness, or injury during my child’s enrollment.
CONSENT FOR THE USE OF PHOTOGRAPHS/VIDEO AND NAMES *

I understand that the Club coaches may at times be using video recording to assist in technical and gameplay analysis and that opposing clubs may also which to video for the same purposes. I understand that photographs may be taken and used on our website with the use of the names of thosecaptured in the images. I will inform the Club if I have an objection and do not to be photographed for thispurpose. I consent to City of Birmingham Rockets Basketball Club photographing and videoing my basketball activitiesand also using full names on our website.
Date *

Month Day Year
Date
Parent or Guardian Printed Name *
Parent or Guardian Signature *

Payment Information

If you chose to pay a deposit, please ensure that the remainder of the full payment is made no later than 30th June.
Payment *
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Non-Residential Campers £ 325.00 GBP

Non-Residential Campers Minimum Deposit £ 100.00 GBP

Residential Campers £ 475.00 GBP

Residential Campers Minimum Deposit £ 150.00 GBP

Total £ 0.00 GBP
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HAKEEM OLAJUWON ‘CITY OF BIRMINGHAM ROCKETS’ INTERNATIONAL SUMMER CAMP 2021

Camper Information

Medical Information

Parent or Guardian Information

Emergency Information

Payment Information