Girls Summer Basketball Camp

Girls Windjammer Youth Summer

Basketball Camp Registration Form

Grades 2nd through 8th

Athlete Information

Player Name

First NameLast Name

Guardian / Parents Names

First NameLast Name

Grade entering Fall of 2026

School Attending in Fall 2026

Home Phone

Format: (000) 000-0000.

Cell Phone

Format: (000) 000-0000.

E-mail

example@example.com

Basketball skill level

1 is Beginner, 5 is Advanced

Emergency Contact & Health Insurance Information

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Format: (000) 000-0000.

Does child have any allergies, chronic illness, or medical conditions that would limit high level activity?

Please describe

Parental Permission For Emergency Treatment In the event of illness or accident, I give my permission for emergency treatment by qualified medical personnel for my child, and I authorize the person in charge to take my child to: I give consent for the facility to secure any and all necessary emergency medical care for my child.

Name of Physician / Emergency Medical Care Facility

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Format: (000) 000-0000.

Release of Liability Although the safety of all sport activities is the primary concern, indoor sport activities at Youth Sport Center's facilities may cause injuries and/or death. I expressly assume the risk of injury, death, and/or illness arising from any cause, and agree to waive the right to pursue any claim against the Youth Sport Center and the persons in charge.

I have read and agree to the above conditions

Confirmation E-mail

example@example.com

Payment Option

Camp Registration Fee

Camp Registration

$180.00

Total

Registration is $180.00

Please make checks payable to:

Samantha Bragg

11 Robinson Dr

Rockport, Me 04856