REGISTER AND PAY
Summer Camp
Boys and Girls ages 5-14 Camp Hours 9am-3pm
Location: Saint John Paul II Academy
4001 N Military Trail Boca Raton, FL 33431
Select Which Sessions You Will Attend
July 7- July 11
July 14- July 18
July 21-July 25
July 28 - Aug. 1
Select your dates & rates at the end of this form
Please enter in all requested information
Email
*
example@example.com
Parent/Guardian*
*
First Name
Last Name
Emergency Phone Number*
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Participant Information - 1
*
First Name
Last Name
Age
*
Birth Date
*
-
Month
-
Day
Year
Date
School Name
*
Participant Information - 2
First Name
Last Name
Age
Birth Date
-
Month
-
Day
Year
Date
School Name
Participant Information - 3
First Name
Last Name
Number
Birth Date
-
Month
-
Day
Year
Date
School Name
Check the box to agree to the following health statement:
I certify that the above named applicant is in good health and has my permission to participate in the program. I hereby release and forever discharge Future stars Basketball Academy, Upward Basketball and Saint John Paul II Academy, its coaches, agents and the owners of any fields used from all liability for any personal injury or illness, damage or loss incurred while participating in this camp. I grant permission for my child to be given medical treatment as deemed appropriate to Future Stars Basketball Academy. There will be no refund of tuition, fees, charges, or other payments made to Future Stars Basketball Academy in the event the operation of Future Stars Basketball Academy is suspended at anytime as a result of any act of God, strike, riot, disruption or for any reason beyond the control of Future Stars Basketball Academy.
I Agree to Health Statement
*
Agree
Insurance Name
*
Policy Number
*
Check the box to agree to the following insurance statement:
PARENT/GUARDIAN STATEMENT: I hereby authorize and request the Academy Director to secure the necessary medical care and treatment for my child should the need arise. My child is physically able to participate in all activities. If my child appears ill, I will keep him/her home. I have read the Academy brochure and understand and agree to cooperate with all regulations. I have read, understood, and executed the Future Stars of Basketball Academy Liability Release form. I will be responsible for all costs of medical treatment incurred by the Academy. I authorize Future Stars of Basketball Academy, Upward Basketball and Saint John Paul II Academy to use photographs of my child for the purpose of Academy promotion and/or advertising.
I Agree to Insurance Statement
*
Agree
Does your child have any allergies that we need to know about?
Does your child have any allergies that we need to know about?
Yes
No
Please provide a brief description of your child's allergy
Who is authorized to pick your child up?
Please enter the names of anyone who is authorized to pick up your child from camp.
*
Select The Number of Campers Attending
Want to Pay At the Door ?
Please bring Cash, Check, Venmo or Zelle on the first day of your camp to Andy Russo USE CODE ' coach ' BELOW as a coupon to finalize your registration.
Select The Number of Campers Attending
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( X )
1 Camper
$
325.00
Select Number of Weeks
1
2
3
4
2 Campers
$
550.00
Select Numbe of Weeks
1
2
3
4
3 Campers
$
825.00
Select Number of Weeks
1
2
3
4
Day Rate
$
75.00
Quantity
1
2
3
4
5
6
7
8
9
10
After Care
$
25.00
Quantity
1
2
3
4
5
6
7
8
9
10
Which Day Can We Expect You?
July 7
July 8
July 9
July 10
July 11
July 14
July 15
July 16
July 17
July 18
July 21
July 22
July 23
July 24
July 25
July 28
July 29
July 30
July 31
Aug. 1
Pay with Credit Card
Submit
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