Basketball Camp Registration Template

Will you be attending our next program on November 23?*

YesNo

Will you be joining us for a FREE Lunch?*

YesNo

Which do you prefer for lunch?*

SalmonBaked Chicken

Youth's Name*

First NameLast Name

Grade*

What school are you currently attending?*

Gender*

MaleFemale

Name*

First NameLast Name

E-mail*

example@example.com

Home Number

Cell Number*

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Alternative Phone Number

Is the youth prescribed an inhaler?

YesNo

If yes, please explain any instructions.*

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by this organization, during S.A.F.E Sports & S.T.E.A.M activities. 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 Omega Gold Development Group, Inc., Prince George's County Maryland Public Schools, Prince George's County Maryland Parks and Recreation and affiliates, and affiliates. 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 S.A.F.E. Sports & S.T.E.A.M activities.

In case of injury to said child, I hereby waive all claims against the organizations. Including all coaches, volunteers, presenters 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 S.A.F.E. Sports & S.T.E.A.M. activities. Some of these injuries include but are not limited to, the risk of fractures, paralysis, or death.

I consent to my child participating in the S.A.F.E. S.T.E.A.M. initiative. Please make the following selection below.

Confirmation

By acknowledging and checking the box below, I am consenting my consent that will have the same effect as an original manual paper signature. The check box will be equally as binding as an original manual paper signature.

Join 2024 - 2025 S.A.F.E. Sports & S.T.E.A.M. Activities

Space is limited to a "first come - first serve basis"

S.A.F.E. Sports & Robotics Registration Form

YOUTH INFORMATION

Parent/Guardian Information

Emergency Information