Registration

Please print and complete this page and with cheque send to:

Beaches Basketball Camp
24 Crossovers St, Toronto, Ontario, M4E 3X4


$250.00 Cheque Payable to: Beaches Basketball Camp

Camper Information:

Last Name:
First Name:
Gender: M F
Birthdate: (MM/DD/YR):
Youth Shirt Size:
Skill Level:
Health Card #:
Medical Conditions: Please describe and known medical conditions.  Indicate if your child is required to take medication or medical precautions for this condition ( e.g. epi-pen, inhalers etc..)________________________________________________________________________________________________________

Parent/Guardian Information:


Last Name:
First Name:
Home Phone:
Mobile Phone:
Address:
City:
Postal Code:
Email:


( ) I authorize my child to leave camp on their own.
( ) I authorize my child to leave camp at lunch time.
( ) My child must be picked up after camp.  I authorize the following people to pick up my child:
Name/Phone:_____________________________________
Name/Phone:_____________________________________
Name/Phone:_____________________________________


Release Form:


While staff will make every reasonable effort to minimize exposure to known risks associated with registrant's participation in the program, I hereby acknowledge that my child may be required to participate in various physical activities that may involve risk of injury.  I permit my child to participate in the full range of Program activities.  I hereby release and forever discharge the Beaches Basketball organization, its respective officers, directors, employees, volunteers and agents, and their respective successors and assigns from any and all liability, actions, causes of action, claims, demands or damages of any kind with respect to death, injury, loss, or damages to any person arising out of or connected with preparation for, participation in, this program.


Name of Parent/Guardian:___________________________
Signature:________________________________________
Date:____________________________________________