No Limit Basketball 6th annual Fast Break Basketball Camp

Player Information
Player Name*

First NameLast Name
Age*
Date of Birth*

MonthDayYear
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent Information

Primary parent info required
Mothers Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mother Email*
example@example.com
Mother Cell Phone Number*
Please enter a valid phone number.
Mother Work Phone Number
Please enter a valid phone number.
Father Name*

First NameLast Name
Father Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Father Email
example@example.com
Father Cell Phone Number*
Please enter a valid phone number.
Father Work Phone Number
Please enter a valid phone number.
Emergency Contact Information
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Gender*
T shirt size

Adult xxlAdult xlAdult LAdult medAdult smallyouth Lyouth medyouth small
Experience
Number of years playing organized basketball

Beginner1yr2yrs3years +
Players goals: things specifically wanting to improve on
Medical History
Please list all relevant medical information such as allergies, medications or pre-existing conditions :
First Name Last Name Name of Health Insurance co. blanks Policy #no.blank
MANDATORY MEDICAL RELEASE & WAIVER FORM

WAIVER:
I, the parent/guardian of the individual, a minor (the “Player”), do hereby permit the Player to participate with No Limit
Basketball (NLB) and certify that the Player’s physical condition is sufficient for full participation. I understand that the
Player’s participation with NLB involves an element of risk, possible danger and/or accidents. I also understand that the
Player’s participation at NLB may include activities involving Players of different ages participating together. If an emergency
arises during any event while the player is participating with NLB, I authorize NLB, its Coaches, Administrators, Management
and/or Volunteers to provide or arrange transportation to/ from a medical facility as needed. I assume all risk and agree to
hold harmless NLB from all claims resulting from accidents and injuries that arise from participation in any session or from
transportation provided or arranged by NLB. Knowing all of these risk, I hereby assume these risk and I hereby release and
discharge NLB, Youth Basketball of America (YBOA) and Amateur Athletic Union (AAU) from any and all liability resulting from
the Player’s participation in any aspect of NLB. I understand that it is my responsibility to inform NLB staff of any medical
conditions or other special needs the Player might have and will notify the appropriate individuals of
any health issues that might in any way affect the Player’s active participation with NLB. I hereby give permission for NLB
staff and/or trainer to administer prescriptions or over the
counter medication as needed. I assume responsibility for any and all cost associated with treatment of the Player for any
injury or health issues that arises during the Player’s participation with NLB.
Parent/Guardian Signature:
Date:
Athletes without a completed medical release waiver on file will not be allowed to participate in the program
Locations
Dates attending*

MonthDayYear
Date
Things to bring (optional)

Extra TshirtTowelcombination/ or pad lock for lockerswater bottlebasketball shoes
Payment
Cost : $300.

Monday - Friday 9am - 3pm

included camp tshirt

lunch & snack

Daily drop in rate: $65.

Multi family discounts available

Multi Camp discounts

if attending more than one week discounts apply

Payments due prior to attending
Cost $300. per player multi family discounts available multi camp discounts
Monday- Friday 9am-3pm
Payment type*
Drop off/ Pick up info
Camp begins at 9am

check in will be early as 8:45am

pick up is 3:00pm -3:10pm

parents or authorized rep must check out player via sign out sheet

late charge assesed after 3:15pm-$10.

Lunch will be 12pm-12:30pm

parents welcomed to drop by at any time

any questions please contact Coach Johnson 404 493 0490

nolimitbasketballga@gmail.com
Name of Person(s) authorized for pick up*
full name, ID may be required
Signature

Clear
Should be Empty:

Player Information

Parent Information

Emergency Contact Information

Experience

Medical History

Payment

Drop off/ Pick up info