Second Wind Basketball Academy Registration Form

Welcome to the Second Wind Basketball Academy registration form. Please complete the form below for the upcoming (DATE/SESSION) camp. We look forward to seeing you there!
PLAYER INFORMATION
Player First Name
Player Last Name
Date of Birth

MonthDayYear
Date
Grade Entering Fall 2026
School Attending
Gender

Other
PARENT/GUARDIAN INFORMATION
Parent/Guardian Name
Relationship to Player
Email Address
example@example.com
Cell Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Secondary Emergency Contact
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
MEDICAL INFORMATION
Does the participant have any allergies?
Does the participant have any medical conditions?
Insurance Company
Name of Primary Insured
Policy Number
Does the participant require medication during camp?
Additional Medical Notes
MEDICAL AUTHORIZATION
Please read and review the Medical Authorization Statement
I have read and agree with the Medical Authorization Statement
LIABILITY WAIVER
Please read and review the Liability, Risk, and Assumption Waiver
I have read and agree with the Liability, Risk, and Assumption Waiver
CODE OF CONDUCT
Please read and review the Code of Conduct
I have read and reviewed the Code of Conduct with my camper
T-SHIRT SIZE
Select preferred t-shirt size below
I Agree
LET US KNOW
How did you hear about us?
I Agree
PAYMENT
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Half-Day, Morning Academy Pass [9am-12pm]
3 Days, November 23-25 (Total Cost)

$125.00



Half-Day, Afternoon Academy Pass [1pm-4pm]
3 Days, November 23-25 (Total Cost)

$125.00



Full-Day Academy Pass [9am-4pm]
3 Days, November 23-25 (Total Cost)

$195.00



Total

$0.00
Should be Empty:

PLAYER INFORMATION

PARENT/GUARDIAN INFORMATION

MEDICAL INFORMATION

MEDICAL AUTHORIZATION

LIABILITY WAIVER

CODE OF CONDUCT

T-SHIRT SIZE

LET US KNOW

PAYMENT