PREMIER BASKETBALL INSTRUCTION

Home     Register Online      Register Manually      Privacy Policy
 
Camp Registration
Complete the information below to register. This information is securely transmitted and used only to contact you and to have available for camp staff and emergency personnel. Refer to our privacy policy for complete details.

Camper

First Name: Last Name: Age:


Street: City: State:
Zip: Phone: School:
Email: Verify Email:

Physical limitations or medical concerns we should be aware of:

Medical Ins Carrier: Group/Policy Number:
Doctor Name: Doctor Phone:

Parent/Guardian

Full Name: Mobile Phone: Other Phone:
Street: City: State:
Zip: Email: Verify Email:

Emergency Contact

Full Name: Primary Phone: Secondary Phone:

Comments or additional information

Include sibling name if you are requesting a sibling discount.

Authorization

By checking this box, I affirm I am the parent/legal guardian of the Camper named herein. Further:
  • I acknowledge the risk of serious injury from sports activities involved in this program is always present due to the nature of the sport.
  • I authorize the staff of Dublin Gaels Basketball Camp (Camp) to act for me in situations requiring medical attention.
  • I hereby waive and release all those affiliated with the Camp from liability related to injuries or accidents resulting from camp activities.
  • I understand the Camp retains the right to use photographs of campers for marketing purposes.
  • I understand that any camper who does not abide by Camp rules and regulations may be subjected to dismissal without reimbursement.
  • I understand reimbursement for cancellations, including injuries and/or sickness, will be in the form of Camp credit.