PHRESH START - Youth Camp Registration Form
AUGUST 3RD 2024 - 12PM-3PM AT THE PPHACILITY
Participants Details
Participates Name
First Name
Last Name
Cell Phone
Please enter a valid phone number.
E-mail
*
example@example.com
School Year
*
Please Select
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
Gender
Male
Female
Date of Birth
-
Month
-
Day
Year
Date
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Parent Details for Correspondance
Parent/Guardian Name
First Name
Last Name
Parent Mobile Phone
Please enter a valid phone number.
Parent email
example@example.com
Emergency Contact 1
Emergency Contact Name
First Name
Last Name
Home Phone
*
Home Phone
Please enter a valid phone number.
Email
example@example.com
Relationship to Participant
*
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Registration confirmation
I understand that this is a free camp and insure my son/daughter that is participating is in good health and will not hold the Phhacility responsible for any injuries, sickness or death when they participate in the basketball camp.
*
Yes
Submit Form
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