6.2023 Saturday Clinic Registration

EPIC Basketball Saturday Clinic

June 10th , 9am - 12pm * Unionville High School - Grades 3-9
Student Name*

First NameLast Name
Parent/Guardian Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent E-mail*
example@example.com
Phone Number*
Emergency Contact*

First NameLast Name
Phone Number*
Grade Entering: *
Medical Concerns*
Insurance Co. & Policy Number*
I/We hereby consent for my child to participate in the EPIC Girls Basketball Camp. I/We verify that she is physically capable of participating in strenuous physical activity. I/We acknowledge participation carries risk of injury. I/We waive, absolve and indefinitely release Fred C. Ellzy, the staff of EPIC Basketball against any claim as a result of participation in the camp. I/We voluntarily and knowingly acknowledge, accept and assume the risks that come with physical activity.
A Registration fee of $45/camper can be can be submitted via Check or Venmo (@Fred-Ellzy). Check payments should be made payable to: Fred Ellzy and sent to Unionville High School Athletics, 750 Unionville Road, Kennett Square, PA 19348. Payment will also be accepted the day of camp.
Parent Signature*

First NameLast Name
Should be Empty:

EPIC Basketball Saturday Clinic