*****Participant Information*****

Participant Name:  

Billing Address:  

Billing Address:  

City:  

State:  

Zip:  

Email:  

Home Phone:  

Cell:  

Date of Birth:  

Grade:  

Height:  

Weight:  

Player Position:  

Shirt Size:  

School Name:  

*****Registration Payment*****
(Payments must be paid when registering.)

Select Credit Card Type: Select Type Visa Discover Master Card AMEX

Name Printed On Card:  

Credit Card Number: - - -

Credit Card Security Code:  

Exp/Date: MM/YY  

Charge Amount: $  

No Insurance Provided Notification.

Please read indicate accept terms below:

I understand that there is no insurance provided for in the cost of this program.
I will provide for health and any other coverage on my own behalf or on behalf of my child. I understand that there are inherent risks associated with athletics, including basketball camps, that may involve the potential for injury. I take full responsibility for any such occurrence. (Parent/Guardian to sign if applicant is under 18 years old)

Accept Terms of No Insurance:
Select One (required) Yes, I accept No, I do not accept