Registration Form for:
TAMAQUA LADY RAIDERS BASKETBALL CAMP
GIRLS ENTERING GRADES 3rd-8th
Tuesday July 22nd, Wednesday July 23rd, Thursday July 24th
5:00-8:00 PM
Full Name of Camper: ______
DOB: ______AGE: ______ENTERING GRADE: ______
HEIGHT: ______POSITION: ______YEARS PLAYED: ______
Shirt Size Preference, please circle one:
Youth— SM MD LG
Adult— SM MD LG XL
HOME ADDRESS: ______
______
______
E-MAIL ADDRESS: ______
PHONE NUMBER: ______
If not available, list an emergency contact name & number:
PRE-EXISTING CONDITIONS:
Does your child have any injuries or conditions that presently exist that would limit her from camp activities?
Yes No If yes, please describe: ______
______
______
Does your child use an inhaler for asthma?
Yes No
Mail completed form, parent/guardian signature, and camp fee to:
Erika Davis
275 Mush Dahl Rd.
New Ringgold, PA 17960
Checks can be made out to: Erika Davis
Please read below and sign/date:
I acknowledge that participation in basketball camp has an inherent risk. The child named on this form has my permission to participate in the designated Tamaqua Lady Raiders Basketball summer athletic camp. I understand that camp participation will involve significant physical activity, which could result in injury. I certify that my child is in good physical condition and is fully able to participate. I assume all risk incident to my child’s participation and release Tamaqua Lady Raiders Basketball Camp Staff and Tamaqua Area School District employees, agents, offices, and volunteers from all liability claim, expenses, and actions, which may arise from injury or harm to the child as a result of camp participation. In the event of a medical emergency, I authorize the Tamaqua Staff to designate a hospital, physician, or emergency personnel to provide care (including hospitalization, if necessary) to the child and release Tamaqua Staff and School District from any liability for injury or harm to the child that may result from this medical care. I understand and certify that responsibility certify that my child is covered by adequate medical insurance. Please understand that the Tamaqua Lady Raiders Basketball Camp is not responsible for and does not carry insurance. Parents and/or guardians must provide insurance for their child.
Parent/Guardian Signature______
Parent/Guardian Name Printed ______
DATE: ______
Registration deadline: Sunday July 13th – any registration forms will be accepted after this date, however, a t-shirt will not be guaranteed!