Speed Camp - Xplosive Edge

Speed Camp - Hosted by Xplosive Edge

Ages 11-18
Going Vertical Basketball Academy

10700 Sapp Brothers Drive, Omaha, NE 68138
Athlete Information
Athlete's Name*

First NameLast Name
Birth Date*

MonthDayYear
Gender*

MaleFemale
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Referred By:
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship
Phone Number*

Area CodePhone Number
Sessions Per Week:*

Two Sessions
Select Session(s)*

4:00 PM - 5:00 PM (M, T, W, Th)8:15 AM - 90:00 AM (Saturdays)
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
CLICK HERE TO SET UP PAYMENT BEFORE PRESSING SUBMIT (TWO Sessions Per Week)
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Speed Camp - Hosted by Xplosive Edge