Pa Sports Basketball Camp Form

Child Information ONLY COMPLETE THIS FORM IF YOU HAVE ALREADY PAID ABOVE

Name

First NameLast Name

age

Shirt Size

Name on back of shirt (Full Name or nickname , Last Name ):

Enter a single or double digit number for back of shirt

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email

example@example.com

Phone Number

Please enter a valid phone number.

Would you like to coach and/or help as a parent volunteer:

YesNO

Invoice Confirmation #

I, the undersigned parent/guardian of the above Player/Child, understand that participation in football activities involves risks, including but not limited to physical injury, illness, or property damage and do hereby grant the authority to the staff of Pa Sports Camp to apply judgment in regards to medical assistance in the event of an accident, injury, or illness if they are unable to contact the parent or guardian. I authorize first aid, a medical diagnosis and treatment which may deem necessary.

I declare and undertake that the Player/Child has passed the necessary health checks and that there is no known health problem that prevents him/her from playing football as of the Registration date. November 30 till January 11th

I, the undersigned, release Pa Sports Camp and any of its coaches, staff, manager, and/or any parent for any responsibility in case of accident, illness, or injury during my child’s enrollment.

I grant Pa Sports Camp the right to photograph and/or video record of my child while football related activities during the Camp. I understand that these visual materials may be used for promotional, educational, or other purposes by the Camp, including but not limited to print, online, and social media platforms

I confirm that the information given in this form is true, complete and accurate. I have read, understand and agree to all statements on this form.

Type Full Name for Confirmation

Date

Parents Information