2024 Central Valley Bballin' Camp Registration

Central Valley Bball Camp Form
Camp Information

Dates: May 28th-29th

Grades/Times:

5th-8th Grade - 8 AM to 11 AM

1st-4th - 12:00 PM to 2:00 PM

Gender: Boys/Girls
Camper Information
Camper's First Name*
Camper's Last Name*
2024-25 Grade*

3rd4th5th6th7th8th9th10th11th12th
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Shirt Size *

YSYMYLSMLXL2XL
Parent/Guardian Information
Name*

First NameLast Name
Cell Number*

Area CodePhone Number
E-mail*
Emergency Information

Only fill out the emergency contact if different than the guardian contact information.
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number

Area CodePhone Number
Does the athlete have any allergies, chronic illness, or medical conditions? If yes, please describe.
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Beranek Bball Staff during the selected camp. In case of injury to said child, I hereby waive all claims against Beranek Bball Staff 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.
Parent Signature
Payment Method

My Products

Camp Registration $50.00

Total $0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

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Central Valley Bball Camp Form

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