Basketball Camp Registration Form

Athlete's Name

First NameLast Name

Grade/ Elite or Fundmental

Name

First NameLast Name

E-mail

example@example.com

Cell Number

Format: (000) 000-0000.

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Format: (000) 000-0000.

Alternative Phone Number

Format: (000) 000-0000.

Is the athlete prescribed an inhaler?

If yes, please explain any instructions.

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by this organization, during the selected camp. In exchange for the acceptance of said child’s candidacy by this organization. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless this organization. All its respective officers, agents, and representatives from any and all liability for injuries to the said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against the organization. Including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including basketball. Some of these injuries include but are not limited to, the risk of fractures, paralysis, or death.

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.

E-Signature

For a better understanding, this is a 3 day camp during the times/days listed on flyer. Each Group will meet those 3 days at the same same time.

Each group will have a ton of opportunity to work on their individual game as well as within a team setting. Live reps, competing and pushing themselves as well as others to get out of their comfort zones.

WAYS OF PAYMENT

Venmo: JustWork_Dolo

PayPal: JustWorkDolo

Apple Pay: 515-723-5289

*Elite Group: $75

Fundmental Group: $65

Please insert Athlete's name in memo

MUST SEND PAYMENT AFTER SUBMITING FORM TO CONFIRM YOUR SUBMISSION

IT'S JUST WORK

Parent/Guardian Information

Emergency Information