2025 Rally Camper Registration

Registration Form

These forms are required for your children to attend camp July 7-11, 2025. If you are registering more than one child, you will need to submit a separate registration form for each child.
Camper's Information
Camper's Name*

First NameLast Name
Nickname (if different)
Date of Birth*

MonthDayYear
Reminder: Rally is for kids aged 5-11.
Gender*
Is this your first time at Rally Sports Camp?

YesNo
Did someone refer you to Rally Sports Camp?
List first and last name of referrer.
School Camper Attends:*
Grade camper will have completed in May 2025*
T-Shirt Size *
Size is not guaranteed, but we will do our best to fulfill your request
Please provide any additional information that you think is important or may affect the camper's ability to fully participate in the camp program. No group or pairing requests will be taken.

Parent's/Guardian's Information, Emergency Contact and Approved Pickups
Parent/Guardian #1
Parent/Guardian #1*

First NameLast Name
Relationship to Child*
Parent/Guardian #1 E-mail*
Parent/Guardian #1 Cell Phone*
Parent/Guardian #1 Work Phone
Parent/Guardian #1 Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian #2
Parent/Guardian #2

First NameLast Name
Relationship to Child
Parent/Guardian #2 E-mail
Parent/Guardian #2 Cell Phone
Parent/Guardian #2 Work Phone
Where would parent/guardian 2 like to be reached while your child is at camp?

Cell PhoneWork Phone
Home Address Same as Parent/Guardian #1?

Yes
Parent/Guardian #2 Home Address, if different from Parent/Guardian #2

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact
Parent/guardian cannot be listed as emergency contacts. List the name of at least one person who can be contacted in the event of an emergency or illness if you cannot be reached. Any person listed should be able to assist in contacting you. At least one person listed must be able to take responsibility for the child in case the parent/guardian cannot be reached.
Emergency Contact Full Name*

First NameLast Name
Emergency Contact Cell Phone Number*
Emergency Contact Relationship to Child*
Any Additional Approved Pickup Names
Only the parent/guardian, emergency contact(s), or the names on the approved pickup list will be able to pick up the camper. You will be required to show valid photo identification in order to pick up the camper.
Approved Pickup #1 First Name Last Name Phone Number
Approved Pickup #2 First Name Last Name Phone Number
Approved Pickup #2 First Name Last Name Phone Number

Health Insurance
Insurance Information*

Health Insurance Company

Health Insurance Insured Name

Policy NumberGroup Number

Postal / Zip Code

Statement of Understanding and Payment
I, the undersigned, hereby authorize Zero Zero Foundation to photograph, take motion pictures, take video footage, and/or make electronic sound recordings of the registered camper (herein referred to as photographic or electronic reproductions).*

YesNo
I authorize the use of any such photographic or electronic reproductions for any purpose, including, but not limited to educational and other public media as may be deemed appropriate by Zero Zero Foundation. (I understand that the camper may be identifiable from such photographic or electronic reproduction)*

YesNo
Sign Document*
Date Signed*

MonthDayYear
Today's Date

My Products*

Camper Registration $195.00

JULY 7-11: 8:30 AM - 11:30 AM

ZeroZero Donation$5.00

Rally Sports Camp is a program of the ZeroZero Foundation! The ZeroZero Foundation is a nonprofit organization in Birmingham, Alabama that provides early intervention to at-risk youth through the power of sports. Donations to the ZeroZero Foundation will provide scholarship opportunities for ZeroZero kids to participate in Rally Sports Camp.

ZeroZero Donation$10.00

ZeroZero Donation$20.00

Enter coupon

Total $0.00

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

Should be Empty:

Registration Form

Parent's/Guardian's Information, Emergency Contact and Approved Pickups

Health Insurance

Statement of Understanding and Payment