T.E. Youth Summer Basketball Camp

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T.E.Y.S.B.C. Registration Form

PLAYER INFORMATION

* First Name:

* Last Name:

* Street:

* City:

* State:

* Zip Code:

Home Phone:

* Birthdate:

Email:

* Gender:

* Grade:

* Tee Shirt Size (Youth Sizes):

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

I am aware that participation in the T.E. Youth Summer Basketball Camp has some inherent risks and injury can occur. On rare occasions these injuries can be serious. In consideration of my child being allowed to participate in the T.E. Youth Summer Basketball Camp, I, the parent/guardian, assume the risk of all injury and agree not to sue Fond du Lac School District, the camp directors, coaches, assistant coaches, agents, or volunteers for any and all injuries caused by or resulting from participating in the T.E. Youth Summer Basketball Camp. By electronically signing this waiver below, I also authorize the use of pictures of the above-named participant to be posted on the T.E. Youth Summer Basketball Camp web site or advertising media published by T.E. Youth Summer Basketball Camp.

I/we agree with the above *

* indicates required fields

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T.E.Y.S.B.C. Registration Form