2023 KYL Winter Camp Registration Form

2023 KYL Winter Camp Registration Form

Please completely fill in all information. This is important so that each camper may have the most enjoyable time possible while protecting the health and safety of all campers. ONLY CURRENT KYL BASKETBALL PLAYERS ARE ALLOWED TO SIGN UP.
Child's Name*

First NameLast Name
Camp Session Attending - (Please note the AA/Pac12 Camp is now full)*

D1 Girls Camp - February 17th - 20th ($149)
Parent Email*

Confirmation Emailexample@example.com
KYL Member ID
Please enter your KYL Member ID. Please contact the KYL Office if you need help locating your child's KYL Member ID or leave this blank.
Team*
Leader*
Departing From*

IrwindaleCovinaUpland
Returning to*

IrwindaleCovinaUpland
Child’s birthdate*

MonthDayYear
Date
Home Phone*
Address*

Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mother’s/Guardian’s Name
Mother’s Cell Phone
Father’s/Guardian’s Name
Father’s Cell Phone
Name of Emergency Contact *
Notify in emergency if parents/guardians cannot be reached:
Address
Cell Phone*
Allergies*

NoneYes
Please enter allergies below:*
Explain any sickness subject to headaches, asthma, earaches, etc and/or physical limitations*
Any limitations in activities?*

YesNo
Explain limitations*
Dietary restrictions?*

YesNo
List dietary restrictions*
Can your child swim*

YesNo
What has not been covered that we should know about your child to understand and help him/her most*
May we give your child Tylenol if needed?*

YesNo
Health Insurance Company*
Policy or Member Number*
READ THE FOLLOWING CAREFULLY

I AGREE TO THE FOLLOWING:
1. I will not allow my child to go to camp if, to the best of my knowledge, my child has, or is immediately prior to camp exposed to any communicable diseases. If my child becomes ill at camp, I, or someone I designate will pick up my child from Mount Kare.

2. I hereby agree to hold harmless Kare Youth League, its employees, agents and representatives and volunteer assistants for any and all problems, adverse reactions or other medical problem(s) resulting from or due to the medications, medical yadministration or applications given to my child. By initialing here, I agree I have read this paragraph and waive any and all rights to seek redress from Kare Youth League, its employees, agents, representatives and volunteer assistants.
Enter Your Initials Here:*
3. I will not allow my child to bring any of the following items: radio, iPod, mp3, cell phone, electronic gizmo of any kind, knife, or snacks.

4. In case of sickness or accident, Kare Youth League has my authorization to secure such medical attention as deemed necessary if unable to communicate with me immediately.

5. I will be responsible to make sure that an adult WILL BE WAITING to greet and pick up my child upon the camp’s return.
Signature*

Clear
Date*

MonthDayYear
Item Key
Member ID or Name
Amount Due

Total Due*

USD

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Should be Empty:

2023 KYL Winter Camp Registration Form

READ THE FOLLOWING CAREFULLY