Mt. Shasta bears basketball camp

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Mt. Shasta b ball camp

PLAYER INFORMATION

* First Name:

* Last Name:

Street:

State:

Zip Code:

City:

Home Phone:

Birthdate:

Email:

* Grade:

* Gender:

PARENT/GUARDIAN #1

* Firstname:

* Lastname:

EMail:

Home Phone:

Work Phone:

* Cell Phone:

PARENT/GUARDIAN #2

Firstname:

Lastname:

Email:

Home Phone:

Work Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

Emergency Contact:

Phone:

Relationship to Player:

Insurance Carrier:

Policy #:

WAIVER INFORMATION

To the best of my knowledge, my child/children is/are in good physical condition and fully able to participate in any senior project Basketball camp in mount Shasta. I am fully aware of the risks and hazards connected with the participation in this event, including physical injury or even death, and hereby elect to voluntarily participate in said event, knowing that the associated physical activity may be hazardous to me and to my property. I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISKS OR LOSS, PROPERTY DAMAGE, OR PERSONAL INJURY, INCLUDING DEATH, that may be sustained by me, or loss or damage to property owned by me, as a result of participation in this course.

I/we agree with the above *

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Mt. Shasta b ball camp