Elevated Experience Basketball Camp Registration Form

Elevated Experience Basketball Camp Registration
STUDENT INFORMATION:
Student Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade*
Name of School*
Shirt Size*
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
i do hereby agree to release and hold harmless the Initiatives, The Joseph Legacy as well as Momentous Mentoring and , its officers, National Executive Board, employees, members, representatives, agents and assigns from any and all claims, costs, suits, actions, judgments, and expenses for any damage, loss, or injury to my child or damage to my child’s property arising from my child’s participation in field trips, other than damage, loss, or injury that results from gross negligence or intentional infliction of harm by the Initiatives,The Joseph Legacy and Momentous Mentoring, its officers, National Executive Board, employees, members, representatives, agents and assigns.
Parents Signature

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Elevated Experience Basketball Camp Registration