O'Dea Youth Basketball Camp
Participant's Name
*
First Name
Last Name
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Email
*
example@example.com
Parent/Guardian Phone Number
*
-
Area Code
Phone Number
Medical Release
I verify that [participant]
Participant
Is medically insured with
Provider
Policy number
Policy Number
Has dental insurance with
Provider
The above insurance effectively covers any medical or dental cost incurred as a result of participation in the O’Dea Basketball Camp. Further, I authorize the Coaching staff to seek any necessary emergency medical or dental treatment my child may need during the course of camp.
*
Clear
Current Medications
Current Allergies
Acknowledgement of Risk
As the Parent/Guardian of [participant]
*
I acknowledge the potential risk of injury related to participating in football and the physical activities associated with participation in the O’Dea Basketball Camp. I knowingly and voluntarily on behalf of the camp participant accept the risk of all such injuries that could occur due to participation in the camp.
*
Clear
My Products
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Basketball Camp Session 1
$
200.00
June 13-16
Basketball Camp Session 2
$
200.00
June 27-30
Total
$
0.00
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
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