Elementary Basketball Camp Registration

Participant First Name

Participant Last Name

Parent/Guardian's First Name

Parent/Guardian's Last Name

Phone

Address

City

State

Zip Code

Gender

Male Female

Date of Birth

Grade Level

Shirt Size

I herby give my approval for my child's participation in the Stars Basketball Camp. California School for the Deaf, Riverside is not an official facility of the Stars Basketball Camp. Each camper must be covered by her/his parent’s insurance before participating in any of the camp activities. I herby waive, release, discharge the Stars Basketball Camp from any and all rights and claims for damages resulting from injuries to my person(s) or property that may be sustained or suffered in connection with my association with the Stars Basketball Camp. I agree to allow my child’s full participation in this program, including emergency and referral services if necessary.

Allergy to Medications? Food?

Medical Insurance Provider

Emergency Contact

Emergency Phone

I hereby grant STARS Basketball Camp staff full permission to use for publicity and advertising purposes any photographs or video taken of my child during camp.

I hereby grant STARS Basketball Camp to transport my child in approved vehicles on and off premises for program activities and medical care.

Parent/Guardian Signature

Date