Summer Camp Registration Form and Consent

Summer Camp Registration Form and Consents
Camper Name *

Preferred Name First NameLast Name
Campers Shirt Size*
Birth Date*

MonthDayYear
Gender*

MaleFemaleOther
Grade and School Entering in Fall*

GradeSchool
Emergency Contact*

First NameLast NameRelation
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Emergency Contact

First NameLast NameRelation
Phone Number
Please enter a valid phone number.
Email
example@example.com
Select Camp Week(s)*

June 23rd - 27thJuly 7th - 11th
Camp Fees (includes $50 deposit)*

Military Discount- $190Early Bird Discount- $200Sibling Discount- $200Half Day Camp (9am - 12:30pm)- $120
Pizza - Choose Days Needed*

MondayTuesdayWednesdayThursdayFridayNot Needed - Camper Bringing Lunch
Early/Late Shoot Around*

I do not needEarly only (8am - 9am) - Please indicate days needed belowLate only (4pm - 5pm) - Please indicate days needed belowBoth early and late - Please indicate days needed below
Days Needed for Early/Late Shoot Around

MondayTuesdayWednesdayThursdayFriday
Does the camper have any allergies, chronic illness, or medical conditions? If yes, please describe. If medications will be sent with the camper please place all items in a plastic baggie Labeled with campers name as well as appropriate paper work. *
Informed Consent and Acknowledgement I hereby give my approval for my child’s participation in any and all activities prepared by Nimmo Skills and Drills Academy during the selected camp. In exchange for the acceptance of said child’s candidacy by Nimmo Skills and Drills Academy, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Nimmo Skills and Drills Academy, LLC and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions. In case of injury to said child, I hereby waive all claims against Nimmo Skills and Drills Academy, LLC 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*

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Medical Release and Authorization As Parent and/or Guardian of the named athlete, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed. Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me. Permission is also granted to Nimmo Skills and Drills Academy, LLC and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility. This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.*

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Use of Photographs I understand that photographs may be taken during camp for promotional purposes. In the event my child appears in one or more photographs, I hereby give consent to Nimmo Skills and Drills Academy, LLC to use the photograph(s) for promotional purposes only, which may include appearing on the website of Nimmo Skills and Drills Academy, LLC.*

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Photography*

Grant PermissionDeny Permission
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.*

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Summer Camp Registration Form and Consents