Clone of 2026 Fall Soccer Camp Registration Form

Tyler Daniel's Basketball Camp Registration Form - Ages 6 To 9

8 Tuesdays - 9/22, 9/29, 10/6, 10/13, 10/20, 10/27, 11/10 & 11/17 6:00PM To 8:00PM Lindbergh School Gym, 401 Glen Avenue, Palisades Park NJ 07650
Athlete Information
Athlete's Name

First NameLast Name
Birthdate

MonthDayYear
Grade
Gender
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent/Guardian Information
Name

First NameLast Name
Cell Number
Format: (000) 000-0000.
E-mail
example@example.com
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Format: (000) 000-0000.
Does the athlete have any allergies, chronic illness, or medical conditions? If yes, please describe.
-I understand that participation in sports activities involves risks including, but not limited to, sprains, fractures, concussions & other injuries. I voluntarily assume all risks associated with my child's participation.
-I agree to ensure that my child wears all the required safety equipment & follows all safety rules & instructions provided by coaches & program staff.
-I agree that my child & I will adhere to the program's code of conduct, including respectful behavior toward coaches, staff, officials, & other participants. I understand violations may result in dismissal from the program.
-I understand that I am responsible for my child's supervision before & after scheduled program times. I will ensure timely drop off & pick up of my child.
Signature
Should be Empty:

Tyler Daniel's Basketball Camp Registration Form - Ages 6 To 9