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Boys High School Basketball Fall Clinic 2024
Open to boys in grades 9-12
August 22 - October 17, 2023
Tuesdays and Thursdays
7:30-9:00 PM
CCA Gym and CCA Auxiliary Gym
$225
How many participant(s) are you registering? (Max 5 per form)
*
1
2
3
4
5
Participant Information
First Name
*
Last Name
*
Birth Date
*
🛈
+
Grade
*
9th
10th
11th
12th
First Name - 2
*
Last Name - 2
*
Birth Date - 2
*
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+
Grade - 2
*
9th
10th
11th
12th
First Name - 3
*
Last Name - 3
*
Birth Date - 3
*
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+
Grade - 3
*
9th
10th
11th
12th
First Name - 4
*
Last Name - 4
*
Birth Date - 4
*
🛈
+
Grade - 4
*
9th
10th
11th
12th
First Name - 5
*
Last Name - 5
*
Birth Date - 5
*
🛈
+
Grade - 5
*
9th
10th
11th
12th
Current Total:
$0.00
Calculate
Parent / Legal Guardian Information
Relationship to Participant(s):
*
Self
Mother
Father
Legal Guardian
Other
Other
First Name
*
Last Name
*
Address
*
City
*
State
*
Zip
*
Phone
*
2nd Phone
*
Email Address
*
Email Address
*
Health Insurance Information
Participant First Name
*
List any physical or emotional limitations your child/participant may have:
*
Allergies
Heart Murmur
High Blood Pressure
Vision
None
Other or describe any of the above as needed
Other or describe any of the above as needed
Participant First Name - 2
*
List any physical or emotional limitations your child/participant may have:
*
Allergies
Heart Murmur
High Blood Pressure
Vision
None
Other or describe any of the above as needed
Other or describe any of the above as needed
Participant First Name - 3
*
List any physical or emotional limitations your child/participant may have:
*
Allergies
Heart Murmur
High Blood Pressure
Vision
None
Other or describe any of the above as needed
Other or describe any of the above as needed
Participant First Name - 4
*
List any physical or emotional limitations your child/participant may have:
*
Allergies
Heart Murmur
High Blood Pressure
Vision
None
Other or describe any of the above as needed
Other or describe any of the above as needed
Participant First Name - 5
*
List any physical or emotional limitations your child/participant may have:
*
Allergies
Heart Murmur
High Blood Pressure
Vision
None
Other or describe any of the above as needed
Other or describe any of the above as needed
By checking this box, I confirm that the participant(s) is/are covered by Health Insurance. Participant(s) must have Health Insurance to participate in this camp. Please provide Health Insurance information below.
*
I confirm that the participant(s) is/are covered by Health Insurance.
Health Insurance Carrier
*
Policy Holder's Full Name
*
Health Insurance Group Number
*
Health Insurance ID Number
*
Health Insurance Phone Number
*
Waiver Information
READ THIS WAIVER, RELEASE, ASSUMPTION OF RISK AND INDEMNIFICATION AGREEMENT FOR RISKS, INCLUDING BUT NOT LIMITED TO, COMMUNICABLE DISEASES (COVID-19)
By clicking on this form, you confirm that you have read and agree to all terms in the above Waiver, Release, Assumption of Risk and Indemnification Agreement for Risks, Including But Not Limited To, Communicable Diseases (COVID-19).
*
I have read and agree to all terms in the Waiver, Release, Assumption of Risk and Indemnification Agreement for Risks, Including But Not Limited To, Communicable Diseases (COVID-19).
An email confirmation and payment receipt will be sent to the email address listed.
If you do not receive both of these emails, you have not successfully registered for the camp. Be sure to check your spam folder.
Please contact camp support at accounting@canyoncrestfoundation.org if you need assistance.