FITNESS TRAINER RICKY ASHTON
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basketball camp registration
PLAYER INFORMATION
Players Name
*
First
Last
Registration Confirmation Email
*
REGISTRATION FEE
Price:
$ 250.00
Home Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Date of Birth
*
MM/DD/YYYY
T-Shirt Size
*
Gender
*
Male
Female
PARENT / GUARDIAN INFORMATION
Parent / Guardian Name
*
First
Last
Phone
*
Parent / Guardian 2 Name
First
Last
Phone
HEALTH & INSURANCE INFORMATION
Insurance Provider
Subscriber Name
Subscribe #
Group#
Please list known medical conditions, allergies, dietary restrictions or comments
*
UNZIP YOUR GAME LIABILITY RELEASE Terms & Conditions/Liability Release - IMPORTANT PLEASE READ Unzip Your Game Basketball Camp Waiver, Release & Liability Statement I, the parent/legal guardian of the above named minor, authorize the full participation in the Unzip Your Game Basketball Camp, including all related camp activities. It is my understanding that the voluntary participation in the activities at the Unzip Your Game Basketball Camp is not without inherent risk of injury. In consideration of the minor's participation in the Unzip Your Game Basketball Camp, I hereby release, waive, and discharge Unzip Your Game Basketball Camp, its owners, staff, consultants, and volunteers, Church of St John the Divine, its directors, officers, employees, members, staff, contractors and volunteers from any and all liability, claims, demands, action, and clauses of action whatsoever arising out of or related to any loss, damage, injury, including death, that may be sustained by said minor, whether caused by the negligence of the release, or otherwise while participating in such activity, or in, on or upon the premises where the activity is taking place. I understand that if my child requires medical treatment while participating in the camp, an attempt will be made to notify me. In the event that I cannot be reached, I consent to such treatment for my child as may be deemed necessary under the circumstances, including, but not limited to x-ray examinations, surgery and anesthesia. I hereby give permission for any emergency treatment or medical care by a physician, hospital or medical facility that may be required, including transport during the camp that the minor is in attendance. I will be responsible for all cost of medical attention provided. By attending Unzip Your Game Basketball Camp, I hereby grant permission to Unzip Your Game Basketball Camp to use my child's photograph online and/or in any publications related to the camp and its promotion. I also acknowledge that though my child's photo may not be used at this time, it may be used at the organization's discretion at a later date.
Upon clicking "Complete Registration" below, your information will be submitted and you will be redirected to PayPal for camp registration payment.
Phone
Complete Registration
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