GK Basketball Camp Registration

REGISTRATION FORM

BASKETBALL CAMP
ALL FIELDS ARE REQUIRED TO BE FILLED OUT
Select Camp Location*
Athlete Information

Please complete one camper information section for each camper being registered.
Athlete/Camper*

First NameLast Name
Age*
MaleFemale
Athlete/Camper

First NameLast Name
Age
MaleFemale
Athlet/Camper

First NameLast Name
Age
MaleFemale
Athlete/Camper

First NameLast Name
Age
MaleFemale
Athlete/Camper

First NameLast Name
Age
MaleFemale
Athlete/Camper

First NameLast Name
Age
MaleFemale
Parent/Guardian Information
Name*

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

First NameLast Name
Relationship*
Phone Number*
Alternative Phone Number
YesNo

Greg Kelser Basketball Camp Registreation Fee

Registration Fee

$250.00 Per Camper

$250.00 Quantity
Item subtotal:$0.00

Total

$0.00

Credit Card

Cash App Pay

REGISTRATION FEE: $250 per camper.

PAYING BY CHECK:

Please fill out this form, print and then together with your check mail it to: KELSER, INC 19011 W 10 MILE ROAD, SOUTHFIELD, MI 48075

Make Checks payable to : KELSER INC.
PARENTAL CONSENT

I request that you accept this application for enrollment of my child into the Kelser Basketball Camp. In consideration of your acceptance of this application I release Kelser, Inc., and all of its employees from all claims on account of injuries which may be sustained by my son or daughter while attending the camp.
In the event of sudden illness or accident when I cannot be reached, I authorize the camp to transport or have transported, my child to an appropriate medical facility. I also consent to the performance of such treatment and/or emergency procedures as deemed necessary or advisable by the hospital staff member in charge of the emergency room.

PHOTOGRAPHY RELEASE
I give permission for you to use video tapes and/or photos of my child taken during camp in your advertising literature.
Signature*
Print your name please.
Date*

MonthDayYear
Date
By signing below, I acknowledge and agree to the camp participation and liability terms.
Should be Empty:

REGISTRATION FORM