Shooting 4 The Stars Registration Form

Shooting 4 The Stars Registration Form

Presented By: Magic City Pro-Am
Camp Fee: $125

Dates: June 30th-July 3rd

Time: 9AM-3PM
Location: North Birmingham Rec Center (3501 28th St N, Birmingham, AL 35207)

What to Expect:

Intensive Training: Campers will undergo elite training sessions with professional players Orlando Coleman and Ricky Tarrant, along with expert trainer Devin Gary.

Competitive Games: Engage in competitive matches to apply skills learned during training.

Mental Health Workshops: Interactive sessions focusing on mental well-being, including guest speakers.

Film Study: Learn to analyze game footage to enhance basketball IQ.

Lunch Provided: Daily meals included for all campers.

Camp T-Shirts: Each participant will receive a camp t-shirt on the first day.

Eligibility: Open to boys and girls in grades 5th-12th.

What to Bring: Proper athletic attire and a change of athletic wear for training.

For any further inquiries or details, feel free to reach out to Orlando Coleman (205)-356-7567, Ricky Tarrant (205)-401-0619, Devin Gary (205)-478-4348
Camper's Information
Member ID
Player Name*
Nickname
DOB*

MonthDayYear
Date
Entering Grade in 2025/26*
What school does camper attend?
T-Shirt Size
NOTE - Daily hours for the camp require participants to arrive no earlier than 20 minutes before the start time, which is set for 9:00 AM, with no late arrivals accepted more than 15 minutes after this time. Parents are asked to pick up their campers by 3:15 PM; otherwise, a late pickup fee of $15 will be charged. The camp is open to all boys and girls in grades 5th to 12th, and participants are advised to bring a change of athletic wear for training activities.
Available for all days of camp?*
If No, what day(s) not available?
Please provide any additional information that you think is important or may affect the camper's ability to fully participate in the camp program.*

Parents' Information

Parent/Guardian 1
Parent/Guardian 1*

First NameLast Name
Relationship to Child*
E-mail*
example@example.com
Cell Phone*
Home Phone*
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent's Work/School Name*
Or enter N/A if not applicable
Parent's Work/School Phone
Parent's Work/School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Where would you like to be reached while your child is at camp?*

Cell PhoneWork PhoneHome Phone

Emergency Contacts/Authorized Pickup

Parents cannot be listed as emergency contacts. List the name of at least one person who can be contacted in the event of an emergency or illness if you cannot be reached. Any person listed should be able to assist in contacting you. At least one person listed must be within one hour of the center/home, able to take responsibility for the child in case the parent/guardian cannot be contacted and should be at least 18 years of age. The first emergency contact must live no more than 1 hour away and be over the age of 18.
Heading

Emergency Contact #1
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number*
Secondary Phone Number*
Relationship to Child*
Heading

Emergency Contact #2
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number*
Secondary Phone Number*
Relationship to Child*

Payment and Statement of Understanding
Payment Options ($125 per camper)*
The camp leaders has permission to secure emergency transportation for my child in the event of an illness or injury which requires emergency treatment. The emergency transportation service will determine the facility to which my child will be transported.*
Type first and last name above to consent
WAIVER AND RELEASE OF LIABILITYBy signing this waiver, I acknowledge and agree to the following:Assumption of Risk: I understand that participation in the Shooting 4 The Stars camp involves physical activity and potential risk of injury. I voluntarily assume all risks associated with my participation.Release and Waiver: I hereby release and hold harmless DreaMentali Foundation, Magic City ProAm, Birmingham Park and Recreation, the City of Birmingham, event sponsors, staff, volunteers, and affiliates from any and all liability for injuries, damages, or losses arising from my participation.Medical Consent: In the event of injury or illness, I authorize event organizers or their representatives to obtain necessary medical treatment on my behalf and assume responsibility for any resulting expenses.Photo/Video Release: I grant permission for any photographs, video, or media coverage taken during the event to be used for promotional purposes by DreaMentali Foundation, Magic City ProAm, and their partners without compensation or additional consent.Code of Conduct: I agree to conduct myself in a respectful, sportsmanlike manner and follow all rules and directions provided by the tournament staff.Parental Consent (if under 18): I am the parent or legal guardian of the participant and consent to their participation under the terms listed above.*
Type first and last name above to consent
Sign Document*
Date Signed*

MonthDayYear
Should be Empty:

Shooting 4 The Stars Registration Form

Camper's Information

Parents' Information

Emergency Contacts/Authorized Pickup

Heading

Heading

Medical / Health Information

Payment and Statement of Understanding