Western Avenue Basketball Camp Registration Form

Western Avenue Community Center Summer Basketball Camp

Complete the form below to sign up
PARTICIPANT NAME *

First Name Last Name
Phone Number: *

Area Code Phone Number
Birth Date: *

Month Day Year
Age *
Gender *
Race *
School *
type n/a if not currently enrolled in any school
Grade *
type n/a if not currently enrolled in any school
Method of transportation TO program
Method of transportation FROM program
T-SHIRT SIZE XS S M L XL 2X* *
Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Student health/dietary concerns
WACC does not apply or administer ANY medications to members. Please make arrangements with administrative staff prior to attending programming
PARENT/GUARDIAN NAME *

First Name Last Name
PARENT/GUARDIAN Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
E-mail Address *
example@example.com
EMERGENCY CONTACT NAME *

First Name Last Name
EMERGENCY CONTACT Phone Number: *

Area Code Phone Number
APPROVED PICK UP LIST

Persons on this list must come in and show ID before member will be released
Name

First Name Last Name
Name

First Name Last Name
Name

First Name Last Name
NO CONTACT NAME(S) (Please list anyone the member is NOT to have contact with)

First Name Last Name
Membership Rules

Western Avenue reserves the right to change or modify these rules at any time
Students are expected to be respectful and courteous to fellow members and staff of WACC. Refusing to follow our behavior guidelines may lead to possible suspension or immediate removal from our youth programs:
- Absolutely no physical or verbal altercations between members or towards WACC Staff. Physical fighting, arguing, using offensive or vulgar language or any other behavior considered inappropriate will not be tolerated
- Threats of violence, bullying, or teasing any member or WACC staff is NOT permitted
- Please wear appropriate clothing. Items with curse words, vulgar language or pictures are NOT permitted. Members will be asked to leave if there are no alternate clothing options
- Ladies: please no crop tops that show your belly button), short shorts or revealing clothing of any kind
- Gentlemen: please keep your shirts on and no sagging pants
- For safety reasons tennis shoes must be worn EVERYDAY. Please NO open toed shoes, sandals, crocs or slides
Members are NOT allowed to sign themselves out unless we receive prior notice or permission from parent/guardian. In the event that a member voluntarily leaves the premesis, all responsible parties will be notified. Otherwise, members will be released at to a responsible party at the end of programming.
Prior arrangements need to be made for members who walk or ride a bike to WACC.

Participants must treat WACC equipment, supplies, and facilities properly and with care. WACC is not responsible for any lost, stolen, or damaged items.

Partcipants shall not posess any objects that might be used or considered a weapon.

NO illegal items or substances allowed on the premesis i.e. alcohol, tobbaco, vapes or paraphernalia. No sexual language, gestures or conduct permitted.

Students are expected to partcipate in all activities and cell phone usage will be monitored.
Rules *

I have read, understood, and accepted the rules for membership.
Parent Permissions
I give my child permission to participate in programs at Western Avenue Community Center. I understand that my child’s partcipation in any recreational activities or programs at Western Avenue Community Center at my own risk. WACC is not liable for any injuries, or even death, that may occur to my child during partcipation
Parent Permission *

I have read, understood, and accepted the PARENT PERMISSION POLICY for membership.
LATE DROP OFF and LATE PICK UP POLICY

Youth programming begins on time. Unless prior arrangements have been made, any member arriving more than 30 minutes late will not be permitted to participate that day. In the event that your child will be late, please notify a WACC staff member at the earliest opportunity

Youth programming ends on time (unless prior notification is given) Parents may begin picking up 15 minutes before the end time). In the event that you will arrive late, please notify a WACC staff member at the earliest opportunity. If members have not been picked up 30 minutes after program end, WACC will contact the local authorities.
Late Drop off and Pick Up Policy *

I have read, understood, and accepted the late drop off and late pick up policy for membership.
PHOTO/VIDEOS/MEDIA: I am giving consent for photographs, videos and/or like materials in which myself, my son/daughter may appear, to be used in any of Western Avenue Community Center's (WACC) promotional, informational, or social media materials.
Photo/Media *

I have read, understood, and accepted the MEDIA POLICY for membership.
Parent/Guardian Signature

Clear
Once you submit your application, we will contact you shortly to complete your membership application. Thank you!
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Western Avenue Community Center Summer Basketball Camp

APPROVED PICK UP LIST

Membership Rules

Parent Permissions