Texas Stampede Basketball Camp Registration

Athlete's Name*

First NameLast Name

Athlete’s School *

Grade*

Date of Birth*

Basketball Experience *

What team are you Intrested in joining

Stampede Program*

MaleFemaleBeginner/Developmental

Gender*

MaleFemale

Jersey Size*

Jersey number request (Pick 3)*

Name*

First NameLast Name

Home Address*

Home Number

Area CodeNumber

Cell Number*

Area Code Number

E-mail*

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Area Code Number

Alternative Phone Number

Area CodeNumber

Is the athlete prescribed an inhaler? If yes, please explain any instructions. Any medical conditions please explain.*

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by this organization. In exchange for the acceptance of said child’s candidacy by this organization. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless this organization. All its respective officers, agents, and representatives from any and all liability for injuries to the said child arising out of traveling to, participating in, or returning from selected Texas Stampede activities.

In case of injury to said child, I hereby waive all claims against the organization. Including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including basketball. Some of these injuries include but are not limited to, the risk of fractures, paralysis, or death.

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.

E-Signature*

Texas Stampede Basketball

Athlete Information

Parent/Guardian Information

Emergency Information