2024 RBA SUMMER BREAK CAMP

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PLAYER'S NAME* This field is required.

First Name

Last Name

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PLAYER'S DATE OF BIRTH* This field is required.

Date

3

PLAYER'S AGE* This field is required.

4

SUMMER BREAK CAMP WEEK* This field is required.Select the week you plan on attending

5

PARENT/LEGAL GUARDIAN NAME* This field is required.

First Name

Last Name

6

PARENT/LEGAL GUARDIAN PHONE NUMBER* This field is required.

Please enter a valid phone number.

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PARENT/LEGAL GUARDIAN EMAIL* This field is required.

example@example.com

8

EMERGENCY CONTACT* This field is required.

NAME OF EMERGENCY CONTACT

PHONE NUMBER

RELATIONSHIP TO PLAYER

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PARENT/LEGAL GUARDIAN SIGNATURE* This field is required.

Clear

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EMERGENCY WAIVER
Retro Basketball Academy has permission, in the event of an emergency and in case parent/legal guardian are unavailable, to authorize any physician, nurse practitioner or medical personnel to examine, interview, test and if necessary, treat my child Player's First Name * Player's Last Name * as they may deem advisable.
Today's Date * Signature

11

DEPOSIT & FEE DUE DATES
Payment to be made on our website www.retrobasketballacademy.com

I Parent/Legal Guardian First Name * Parent/Legal Guardian Last Name * agree to submit fees for Retro Basketball Academy Summer Camp by the given deadlines.

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RELEASE AND WAIVER
I HEREBY GIVE MY CONSENT FOR THE ABOVE-MENTIONED PARTICIPANT TO PARTICIPATE UNDER THE RETRO BASKETBALL ACADEMY SUMMER BREAK CAMP. I AND THE ABOVE-MENTIONED PARTICIPANT AGREE TO ABIDE BY THE RULES OF THE RETRO BASKETBALL ACADEMY SUMMER BREAK CAMP. I HEREBY ACKNOWLEDGE THAT BASKETBALL IS A PHYSICAL SPORT AND IN SO DOING I WILL NOT HOLD RETRO BASKETBALL ACADEMY, ITS BOARD OF DIRECTORS, COACHES, OR REPRESENTATIVES RESPONSIBLE FOR ANY INJURIES CAUSED TO A MEMBER ARISING OUT OF HIS/HER PARTICIPATION IN RETRO BASKETBALL ACADEMY SUMMER BREAK CAMP AND AGREE TO INDEMNIFY THE RETRO BASKETBALL ACADEMY FOR ANY SUCH INJURY. I FURTHER ASSUME FULL RESPONSIBILITY FOR ANY DAMAGE CAUSED BY THE PARTICIPANT TO ANY GYM PREMISES OR EQUIPMENT. MY SIGNATURE ACKNOWLEDGES THAT I ACCEPT RESPONSIBILITY FOR THE FEES AND THAT I HAVE READ AND AGREED TO THE TERMS AND CONDITIONS LISTED ABOVE AND THE NO REFUND POLICY. I AM AWARE THAT CHANGES CAN OCCUR TO THE RETRO BASKETBALL ACADEMY REGISTRATION AND INFORMATION FORMS. I HAVE CAREFULLY REVIEWED AND UNDERSTAND THE ABOVE PROVISIONS AND AGREE TO BE BOUND BY THEM. I VOLUNTARILY AND IRREVOCABLY GIVE MY CONSENT AND AGREE TO THIS RELEASE AND WAIVER. Parent/Legal Guardian Signature *