IVC Basketball Camp Registration 2019

Complete this form for each player

Select Camp Session

Select Camp Session -- No more choices left --
Camper Name Camper Name First Last
Camper's Age during camp
Gender

Gender Boy Girl
T-Shirt Size

T-Shirt Size Child - S Child - M Child - L Child - XL Adult - S Adult - M Adult - L Adult - XL Other Other
Camper's Mailing Address Camper's Mailing Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Camper Contact Phone # Camper Contact Phone # - ### - ### ####
Camper's School (will be attending in Fall)
Grade Level (in the Fall)
Please note any medical condition(s):
Authorization

I hereby authorize the directors of the IVC Basketball Camp to act according to their best judgement in any emergency requiring medical attention and I hereby waive and release Imperial Valley College; IVC Basketball; and the IVC Foundation, Inc; from any and all liability for any injuries or illness incurred while at the IVC Basketball Camp.
I will be responsible for any medical or other charges in connection with my child's participation. I know of no mental or physical problem which may affect my child's ability to safely participate in this program.
Parent / Guardian Name Parent / Guardian Name Title First Last Suffix
Parent / Guardian's Email
Camper's Health Insurance Company
Insurance Policy #
Emergency Contact Emergency Contact First Last
Emergency Contact Phone Emergency Contact Phone - ### - ### ####
$0

Total