Basketball Camp Registration Template

ALL-GIRLS Sirena Tuitele Instructional Basketball Camp Registration
Athlete Information
Athlete's Name*

First NameLast Name
Grade: 4th-12th*
Gender*

FemaleMale
Parent/Guardian Information
Name*

First NameLast Name
E-mail*
example@example.com
Home Number
Cell Number*
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Alternative Phone Number
Is the athlete prescribed an inhaler? *

YesNo
If yes, please explain any instructions.*
Dietary Restrictions *
Proof of Insurance (REQUIRED) *

Cancelof
Parental Consent and Waiver of Liabailty
I hereby allow my , [Child’s Full Name]* to participate in any and all activities organized by [Sirena Tuitele Instructional Basketball Camp] during the selected camp session(s).
In consideration of the acceptance of my child’s participation, I voluntarily assume all risks and hazards incidental to the activities, including transportation to and from the camp. I hereby release, absolve, and hold harmless [Sirena Tuitele Instructional Basketball Camp], its officers, agents, employees, coaches, volunteers, and representatives, as well as any sponsoring agencies, advertisers, and, if applicable, owners or lessors of premises used for camp activities, from any and all liability arising from injury to my child.

I understand that participation in sports, including basketball, carries an inherent risk of injury. These risks include, but are not limited to, fractures, concussions, paralysis, or even death. I acknowledge that I am fully aware of the potential dangers and accept them on behalf of my child.
Media Release Consent
I also grant [Sirena Tuitele Instructional Basketball Camp] media team the right to take photographs and/or video recordings of my child during camp activities. I understand that these images and recordings may be used for promotional, educational, or informational purposes in print, online, or on social media platforms. I waive any rights to compensation or ownership of the images or recordings.
I give consent for my child's image to be used for media and promotional purposesI do not give consent for my child's image to be used
Parent/Guardian Name: *

First NameLast Name
Parent/Guardian Signature: *

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Date*

MonthDayYear
Date
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.

It is required that the athlete and parent/guardian provide an e-signature.
Participant (Athlete) E-Signature *

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Parent/Guardian E-Signature*

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Date*

MonthDayYear
Date
T-Shirt Size*
LIST NAME(S) OF WHO WILL PICK UP ATHLETE: *

My Products

Registration Camp Fee

$130.00

Total

$0.00

Payment Methods

Credit Card

Apple Pay

Google Pay

If SPONSORED please list off sponsor:
Should be Empty:

ALL-GIRLS Sirena Tuitele Instructional Basketball Camp Registration

Athlete Information

Parent/Guardian Information

Emergency Information

Payment Methods