5th Annual Basketball Camp Hosted by Wendell Carter Jr. Male Students 8th-12th Grade
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Campers Name
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First Name
Last Name
Campers Birth Date
*
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Day
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Year
Campers Mobile Number
*
Format: (000) 000-0000.
Campers Email Address
*
example@example.com
Primary Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Select Camp shirt size
*
Small
Medium
Large
Extra-large
Please Provide Health Insurance Information
*
Did you attend the camp last year?
*
Yes
No
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School Information
School Name
*
School Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Year in School
*
Please Select
Middle School (8th)
Freshman (9th)
Sophomore (10th)
Junior (11th)
Senior (12th)
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Family Information
Parent/Guardian's Name
*
First Name
Last Name
Contact Phone Number
*
Format: (000) 000-0000.
E-mail Address
*
example@example.com
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Emergency Contact Information
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Format: (000) 000-0000.
Relationship to Student
*
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Your Reason For Attending This Camp
Please Provide Any General or Food Allergies
*
0/300
Please Provide Any Medical Condition, Current, or Recent Injuries
*
0/300
GENERAL LIABILITY WAIVER
By signing below, I, the undersigned parent/legal guardian of the above-named participant, hereby acknowledge and agree that participation in the 4th Annual A Platform² Foundation Basketball Camp (hereinafter referred to as the “Camp”) involves certain risks, including, but not limited to, physical injury, illness, and property damage. I voluntarily assume all risks associated with participation in the Camp, including any injury, illness, or loss arising from transportation to and from the Camp, activities, and any other related events.I release, waive, discharge, and hold harmless A Platform² Foundation, its directors, officers, employees, volunteers, sponsors, and agents from any and all liability, claims, demands, actions, or causes of action related to any injury, illness, or loss arising from or in connection with the participant’s participation in the Camp, regardless of whether such loss is caused by the negligence of the released parties. I acknowledge that participation in the Camp involves certain inherent risks, including but not limited to, falls, contact with other participants, physical exertion, and exposure to weather conditions. I voluntarily assume all such risks, both known and unknown, and accept full responsibility for my child’s participation.I agree to indemnify and hold harmless A Platform² Foundation, its directors, officers, employees, volunteers, and agents from any and all claims, damages, or costs arising from or related to participation in the Camp, including any injury, illness, or loss sustained during the event.
Signature
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MEDICAL AUTHORIZATION AND EMERGENCY TREATMENT CONSENT
In the event of a medical emergency involving the above-named participant, I hereby authorize A Platform² Foundation and its representatives to seek and obtain medical treatment for my child, including emergency medical care, diagnostic testing, hospitalization, and any necessary medical procedures as determined by qualified medical personnel. I understand that every effort will be made to contact me or the emergency contact listed below.I accept full financial responsibility for any medical treatment rendered as a result of participation in the Camp and release A Platform² Foundation from any liability arising from such treatment.
Signature
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PHOTO AND VIDEO RELEASE
I hereby authorize A Platform² Foundation and its representatives to photograph, video record, or otherwise capture the likeness of the above-named participant during the Camp for promotional, educational, and informational purposes, including, but not limited to, social media, websites, printed materials, and marketing campaigns.I understand and agree that all media shall remain the property of A Platform² Foundation and that neither the participant nor the participant’s family will receive any compensation for the use of such media.
Signature
*
CONSENT AND ACKNOWLEDGMENT
I have read and fully understand the terms and conditions of this waiver and release. By signing below, I acknowledge that I am voluntarily waiving certain legal rights, including the right to sue A Platform² Foundation for any claims arising out of participation in the Camp.
Signature
*
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