Web 2025 EACH ONE REACH ONE BASKETBALL CAMP

Athlete Information
Child's Name*

First NameLast Name
PARENT CONSENT FORM

FOR MORE INFORMATION CONTACT EVETTE HARRIGAN 476-4110
Birth Date*

DayMonthYear
Age*
Gender*

MaleFemale
Address*

Address

Address Line 2
Name of Parent(s)/ Guardian*
Relationship*
Telephone #*
Telephone #
Email Address:
Jersey Size*
Dietary Restrictions/ Allergies:*
Medical Conditions:*
Name of School:*
Name of Football Club:*
CONTACT PERSON IN CASE OF EMERGENCY
Name:
Telephone#:
Informed Consent and Acknowledgement

I/WE {nameOf91}.AS THE PARENT(S)/GUARDIAN(S) OF THE PARTICIPANT HAS MY PERMISSION TO PARTICIPATE IN THE REACH ONE TEACH ONE BUILDING BRIDGES TO SUCCESS BASKETBALL CAMP ACTIVITIES AND THE INFORMATION THAT IS GIVEN ABOVE IS TRUE AND CORRECT.

I/WE GIVE CONSENT TO THE MEDICAL TEAM SELECTED BY THE REACH ONE TEACH ONE BASKETBALL CAMP TO SECURE PROPER TREATMENT FOR MY CHILD. I/WE AGREE AND RELEASE THE EACH ONE TEACH ONE BASKETBALL CAMP, ITS COACHES AND VOLUNTEERS FROM ANY CLAIMS FOR PERSONAL INJURY, LOSS, OR PROPERTY DAMAGE DUE TO PARTICIPATION IN THE SUMMER CAMP.
Please check*

I Agree
Date

DayMonthYear
Date
Confirmation

BY AGREEING ABOVE AND SUBMITTING THIS FORM, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT IS EQUIVALENT TO AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Club Representative Signature
Date

MonthDayYear
Date
Should be Empty:

CONTACT PERSON IN CASE OF EMERGENCY