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Raven High School Summer Basketball Clinic 2023

Registration Form

The Raven High School Basketball Clinic is for players who are interested in being part of the boy’s basketball program next season. Brian Baum, head basketball coach at Canyon Crest Academy and former assistant coach at Emory University, along with other Canyon Crest Academy coaches will stress team and player development.

Open to Students in Grades 9-11

Tuesdays, Wednesdays and Thursdays

May 23rd to June 29th, 2023
3:45-5:45pm - 5/23, 5/24, 5/25, 5/30, 5/31, 6/1, then 9:00-11:00am for the rest of June
Canyon Crest Academy Gym and Auxiliary Gym

All players must be registered as an AAU Athlete Member, please register at:

http://www.aausports.org/default.asp?a=pg_membership.htm

$375 per player

Participant Information

How many participants are you registering? Camp fee $375 per person (max 5) *

First Name *

Last Name *

Birth Date * 🛈 +

Grade This Fall *

First Name - 2 *

Last Name - 2 *

Birth Date - 2 * 🛈 +

Grade This Fall - 2 *

First Name - 3 *

Last Name - 3 *

Birth Date - 3 * 🛈 +

Grade This Fall - 3 *

First Name - 4 *

Last Name - 4 *

Birth Date - 4 * 🛈 +

Grade This Fall - 4 *

First Name - 5 *

Last Name - 5 *

Birth Date - 5 * 🛈 +

Grade This Fall - 5 *

Current Total:

$0.00

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.