BCB

BCB CAMP REGISTRATION FORM
Camper 1
Last
First
Date of Birth

MonthDayYear
Date
Grade Entering
School Attending
Allergies
Camper 2
Last
First
Date of Birth

MonthDayYear
Date
Grade Entering
School Attending
Allergies
Camper 3
Last
First
Date of Birth

MonthDayYear
Date
Grade Entering
School Attending
Allergies
Parent or Guardian 1
Last
First
M.I.
Street Address
Apartment/Unit #
City
State
ZIP Code
Primary Phone
Alternate Phone
Email
example@example.com
Parent or Guardian 2
Last
First
M.I.
Street Address
Apartment/Unit #
City
State
ZIP Code
Primary Phone
Alternate Phone
Email
example@example.com
Mailing Address
Street Address
City
State
ZIP Code
Emergency Contact 1
Last
Street Address
City
State
ZIP Code
Primary Phone
Alternate Phone
Relationship
Emergency Contact 2
Last
First
Street Address
Apartment/Unit #
City
State
ZIP Code
Primary Phone
Alternate Phone
Relationship
Please list here any additional pieces of information that you would like us to know about your camper. In the case of an emergency, we will first attempt to contact the parent/guardians. If they cannot be reached, the camp will contact the above authorized emergency contacts. Please note that by listing authorized emergency contacts, you are also authorizing them to drop off and pick up your child/children. Please enter persons and their phone number(s) authorized to pick-up child from Prime Time in addition to Emergency contact and Parents/Guardians:

Checks Made Payable to BCB Sports Camp, LLC. Registration can be mailed to: BCB Sports Camp 14028 Tahiti Way #414 Marina Del Rey, CA 90292
~Waiver of Liability and Release of Claims~

This Waiver of Liability and Release of Claims is between BCB SPORTS CAMP ("BCB SPORTS CAMP") and the parents or legal guardian ("PARENTS") of The PARENTS represents they have the legal authority to waive BCB SPORTS CAMP's liability and to hold BCB SPORTS CAMP harmless/judgment free from any legal action in which it is not a direct cause of alleged damages to CAMPER. The PARENTS understand and acknowledge the inherent risks and dangers in BCB SPORTS CAMP's activities and affirm CAMPER may engage in all BCB SPORTS CAMP activities except as written below. As such, PARENTS hereby waive BCB SPORTS CAMP's liability and holds it harmless/judgment free from any legal action in which it is not a direct cause of the alleged damages. BCB SPORTS CAMP may provide routine health care, administer prescribed medications, and seek emergency medical treatment it deems necessary for CAMPER. PARENTS agree to release any records necessary for insurance purposes. If the PARENTS cannot be reached in an emergency, BCB SPORTS CAMP may select a physician to secure and administer treatment, including hospitalization, for the CAMPER. The undersigned certifies that they have read this Waiver and Release, understands it, agrees to all of its terms, and hereby willfully enters it.
Date

MonthDayYear
Date
Signature of Parent/Guardian

Clear
Printed Name of Parent/Guardian
MINOR/CHILD PHOTO RELEASE FORM
. the parent or legal guardian of [Child] grant BCB Sports Camp my permission to use the photographs described as Camp Photography for any legal use, including but not limited to: publicity, illustration, advertising, and web content.

Furthermore, I understand that no royalty, fee or other compensation shall become payable to me by reason of such use.
Parent/Guardian's Signature

Clear
Date

MonthDayYear
Date
Parent/Guardian's Name
Child's Name
Phone Number

Sessions Attending (Please Select Quantity Based on Registered Child)
prevnext( X )
Session 1 (7/7-7/11)
$350.00 Quantity



Session 2 (7/14-7/18)
$350.00 Quantity



Session 3 (7/21-7/25)
$350.00 Quantity



Session 4 (7/28 - 8/1)
$350.00 Quantity



Session 5 (8/4-8/8)
$350.00 Quantity



Session 6 (8/11-8/15
$350.00 Quantity



Single Day Registration (please specify day/days via email at cbaele@bcbsportscamp.com)
$70.00 Quantity



Total

$0.00
Should be Empty:

BCB CAMP REGISTRATION FORM

Camper 1

Camper 2

Camper 3

Parent or Guardian 1

Parent or Guardian 2

Mailing Address

Emergency Contact 1

Emergency Contact 2

MINOR/CHILD PHOTO RELEASE FORM