Boys Basketball - MS (7th-8th grade) Concept Camp

First Name *
Last Name *
Mobile *
Email *
Grade *
Birth Date *
Address *
City *
State *
Zip Code *
Medical Information *

List Medications/Medical Conditions here. If none, type N/A

Page 1 of 2

Next >>

Guardian First Name *
Guardian Last Name *
Guardian Cell Phone *
Guardian Email *
Alternate Guardian First Name
Alternate Guardian Last Name
Alternate Guardian Phone
Alternate Guardian Email
Medical Release Information
By registering for this Camp, I agree to the following Waiver & Release of Liability: https://bixbyps.info/cewaiver
Guardian Signature *

I, the parent/legal guardian, agree entirely to the Medical Release Information.: clear

Page 2 of 2

<< Previous

$100.00

Qty:

CAMPER INFORMATION