2022 LSUS Basketball Camp Registration Form

Athlete Information

Athlete's Name *

First Name Last Name

Birth Date *

Month Day Year

Gender *

Male Female

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Parent/Guardian Information

Name *

First Name Last Name

Home Number

Area Code Number

Cell Number *

Area Code Number

E-mail *

Emergency Information

Emergency Contact's Name *

First Name Last Name

Relationship *

Phone Number *

Area Code Number

Alt. Phone Number

Area Code Number

Does the athlete have any allergies, chronic illness, or medical conditions? If yes, please describe. *

Is the athlete prescribed an inhaler? If yes, please explain any instructions. *

Please Select Which Camp Session You Plan To Attend

LSUS Basketball Showcase (July 10th) - $60 Fun Camp (July 11th-13th) - $75

*Payment is due on the first day of camp. Cash, Check or Venmo only.

LSUS Camp Participant Permission & Release/Waiver of Liability

It is to my understanding that the student participating in the camps through LSUS Athletics is a privilege. I acknowledge that participation in these activities may inherent certain risks, including physical injury due to activity related accidents, illness, or even death. I also understand that there may be other risks due to these activities that I may not be aware of at this time.

Release of Liability Waiver

By signing this Waiver Form, I acknowledge that the student listed above is capable of participating in the activities. I also assume all risks of the student participating in the activities, whether such risks are known or unknown to me at this time. I release and hold harmless this organization, leaders, volunteers, and any agents from any claim the student or I may have due to the result of any injury or illness incurred during participation of the LSUS Basketball camps. I accept and assume full responsibility for any and all injuries, damages, and losses that may occur to me from any participation in the camp activities.

First Aid and Medical Treatment

I understand that the student may be in need of first aid or emergency medical treatment due to an accident, illness, or other health conditions. I give permission for the appropriate personnel of the organization to seek and secure any needed medical attention or treatment for the student including hospitalization (if personnel feels necessary). I accept and agree to pay for any fees incurred due to accident or illness.

I acknowledge there is a risk of being injured that is inherent in all sports activities, including basketball, and that the forenamed child is covered by medical insurance as follows:

Insured:

Company:

Policy Number:

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 *

Clear

LSUS Basketball Summer Camps