Camp Registration – Stars Basketball Camp

Participant Name*

First Last

Parent/Guardian Name*

First Last

Email*

Phone*

Address*

Street Address Address Line 2 City State ZIP Code

Gender

M
F

Date of Birth*

MM

DD

YYYY

Grade Level:

Shirt Size

Waiver - Enter your Initials*

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*

Phone*

Enter your Initials*

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.

Enter your Initials*

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*

Type your full name please.

Date*

MM

DD

YYYY

Riverside, CA (Elementary)