Christian Basketball Camp Arizona Basketball Camp Pass It On Basketball Camp Co Ed Basketball Camp Boys Basketball Camp Girls Basketball Camp

Step #1 - Camper Information
Step #2 - Roommate Requests (OVERNIGHT REGISTRATION ONLY)
Step #3 - Medical Information
Step #4 - Waiver Acceptance
Step #5 - Camp Selection
Step #6 - Secure Login and Payment

Step #1 - Camper Information:

Camper First Name:
M.I.:
Last Name:
Gender:
Date of Birth:
Grade Entering:
School Name:
Years of Playing Experience:
Camp Shirt Size:

Step #2 - Roommate Requests (OVERNIGHT REGISTRATION ONLY):

Roommate Request #1 - Campers Full Name:
Roommate Request #2 - Campers Full Name:
Roommate Request #3 - Campers Full Name:
Roommate Request #4 - Campers Full Name:

Step #3 - Medical Information:

Parent/Guardian Full Name:
Day Phone/Cell Phone:	- -
Name of Emergency Contact (other than Parent/Guardian):
Phone #:	- -
Campers Health History (past injuries, allergies, medications):
Is Tylenol OK for your child?:	yes no
Insurance Company:
Name of Policy Holder:
Member I.D. Number:

Step #4 - Waiver Acceptance:

PASS IT ON CAMPS LIABILITY POLICY In the case of an emergency and if I cannot be reached, I authorize the staff of PLAY Basketball Clinics to obtain whatever medical treatment he/she deems necessary for the welfare of my child listed on this application. I further understand that I will be financially responsible for all charges and fees incurred in the rendering of said emergency treatment, regardless of whether or not my medical insurance would cover such charges and fees. In consideration of being permitted to participate in any way in PLAY Basketball Clinics, I, for myself, my heirs, personal representatives or assigns, do hereby release, waive, discharge, and covenant not to sue PLAY Basketball Clinics and its employees from liability from any and all claims including the negligence of PLAY Basketball Clinics and its employees resulting in personal injury, accidents or illnesses (including death), and property loss arising from, but not limited to, participation in PLAY Basketball Clinics. Participation in PLAY Basketball Clinics carries with it certain inherent risks that cannot be eliminated regardless of care taken to avoid injuries. The specific risks vary from one activity to another, but the risks range from minor injuries such as scratches, bruises and sprains to major injuries such as eye injury or loss of sight, joint injuries, heart attacks and concussions to catastrophic injuries including paralysis and death. I agree to indemnify and hold harmless PLAY Basketball Clinics and its affiliates, predecessors and successors, owners, agents, partners, officials, employees and representatives (collectively, the "Corporations Parties") from and against any and all actions, demands, liabilities, losses, claims, damages, costs or expenses, including without limitation court costs and attorneys' fees (collectively, the "Claims"), brought as a result of my child’s involvement in PLAY Basketball Clinics and to reimburse them for any such expenses incurred. In case any provision of this Agreement shall be invalid, illegal or unenforceable, such provisions shall be severed from this Agreement. The validity, legality and enforceability of the remaining provisions of this Agreement shall not in any way be affected or impaired thereby. I hereby authorize PLAY Basketball Clinics to allow the reproduction, dissemination and or publication of my name or likeness for media coverage, public relations, or any other purpose that may involve the use of photographs, films, and/or video tape recording. This is to be done in conjunction with my participating in this PLAY Basketball Clinic event (s) and I understand and agree that I may neither pay a fee to receive individual promotional consideration from my participation in this event (s), nor will I receive any payment for the possible commercial use of my name or likeness. I have read this entire Agreement, and I fully understand its terms and understand that I am giving up substantial rights, including my right to sue. I acknowledge that I am signing the agreement freely and voluntarily and intend by my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law. PASS IT ON CAMPS CANCELLATION POLICY If you have to cancel prior to the first day of camp for any reason, a $50 processing fee will deducted from the deposit. Campers who leave early due to injury will receive a prorated refund. PASS IT ON CAMPS VISION It is the vision and commitment of the coaches to PASS ON to young players 1) the fundamentals, techniques and skills of the game; 2) life skills such as encouragement, commitment, discipline, goal setting, etc. 3) the love of God through Jesus Christ I have read and understand PASS IT ON Camps' Liability, Cancellation Policy and Camp Vision

I accept waiver information I don't accept waiver information

How did you hear about "Pass It On Basketball Camps"
(mark all that apply)?:

BROCHURE WEB SEARCH FRIEND COACH
NEWSPAPER AD POSTCARD PASTOR OTHER

Step #5 - Camp Selection

Step #6 - Secure Login and Payment