ACHIEVE CAMPS

Player Information
Players Name*

First NameLast Name
Birth Date*

MonthDayYear
Age*
Gender*
Grade (Spring 2023)*
Uniform Size:*

Youth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult Large
List Any Allergies and Dietary Restrictions
Medications & Frequency
Who Referred You?
Type N/A if you have not been referred
Player Email
example@example.com
Player Phone Number
Parent / Guardian Information

(All correspondence and and invoices will be sent to this person)
Parent Name*

First NameLast Name
Parent Email*
example@example.com
Relationship to the Player*
Parent Phone Number*
Parent Name

First NameLast Name
Parent Email
example@example.com
Parent Phone Number
Relationship to the Player
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Will you be a coach?

YesNo
Player Photo

Cancelof
Program Information

All Camp Details: K-8th Grade Boys & Girls | 9:00am - 2:00pm | Bring Your Own Lunch | $300
Which Camp Will You Attend?*

Xavier Silas Shooting Camp June 5th - 7thAchieve Basketball Camp June 19th - 21stWill Figures Point Guard Camp June 19th - 21st (K-12th)Dribblers & Kickers Camp July 10th - 12thXavier Silas Shooting Camp II July 17th - 19th
Participation Waiver
Are You Committed To Paying $300 Camp Dues ?*

Yes
Do You Agree To Be Contacted By Achieve Basketball To Submit Payment And Reserve Your Spot?*

Yes
Date*

MonthDayYear
Date
Signature*

Clear
Should be Empty:

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