2018 PTV Basketball Camp

Registration - Path to Victory Basketball Camp, Green Bay, WI (August 6-8, 2018)

One form for EACH child. Please use PROPER CAPITALIZATION (upper and lower case letters)
Child's First Name *
Enter the first name as you would like it printed on the child's name tag
Child's Last Name *
Gender *

Female Male
Grade this fall *

1 2 3 4 5 6
T-Shirt Size *

Youth Small Youth Medium Youth Large Youth XL Adult Small Adult Medium Adult Large Adult XL
Address *
Street Address
City *
State *
Zip Code *
E-mail *

Confirmation Email
Mother's Name
Mother's Mobile

Area Code Phone Number
Father's Name
Father's Mobile

Area Code Phone Number
Contact Person's Name and Phone Number (during camp hours) *
Medical Concerns - Physical limitations, medical conditions, allergies, etc. *

none
Home Church Name *

none
How did you hear about the Path to Victory Camp? *

Flyer Word-of-Mouth Previously attended the camp Social Media
WAIVER: The child named above desires to participate in the basketball camp in August of 2018, located on the property of St Paul Lutheran Church and School. The undersigned parent/guardian acknowledges that there are dangers and risks of injury inherent in sports activities, but still allows his/her child to participate in said activities. THEREFORE, the undersigned, for and in consideration of the opportunity to participate in the Path to Victory Basketball Camp and for other good and valuable consideration, does hereby accept full responsibility for liability and cost of treatment of injury to the above registered person. The undersigned does hereby release the teachers, coaches, assistants, St Paul Lutheran Church and School, and Messiah Lutheran Church from all liability resulting from negligence and agrees to hold them harmless for any injuries and/or damages his/her child may sustain arising out of the activities inherent in a basketball camp. The undersigned further declares and represents that no promise, inducement or agreement not herein expressed has been made to the undersigned, and that this release contains the entire agreement between the parties hereto, and that the terms of this release are contractual in nature and are not a mere recital.
By checking the box below and by signing my first and last name, I am stating that I have read and understood the above statement, and that I agree with its terms. I also understand that checking the box below constitutes a legally-binding signature. *

I agree.
Your First & Last Name *
PHOTOGRAPHY PERMISSION: In addition, the undersigned gives Path to Victory permission to photograph the child named above and to use those photos in print publications and websites (nametags with first names may be visible). I also understand that checking the box below constitutes a legally-binding signature.
Agree to Above Photography Statement *

I agree to the statement above. I do NOT want my child photographed.
When you click the "Submit Form" button below, you will be redirected to a secure website for payment of the $20 camp fee. You can pay be credit card or bank account at this secure website used by Messiah Lutheran Church. Please remember that payment must be made before a child will be included on our automated registration lists and considered registered.
Enter the message as it's shown *
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Registration - Path to Victory Basketball Camp, Green Bay, WI (August 6-8, 2018)