YBA summer Camp Registration

TO REGISTER and PAY BY CHEQUE OR CASH ONLINE FORM

The following form is designed to allow parents to submit registration information for their daughter or son while paying by cheque or cash.

The submission of this form does not guarantee registration. Upon receipt of the cheque or payment the form will be processed.

KW YBA Summer Basketball Camp Online Registration Form

*Email Address: Please enter your email address.

*Parent/Guardian first name:

*Parent/Guardian last name:

*Parent Phone # (house)

*Parent Phone # (cell)

*Street Address

*City:

*Postal Code:

*Player's Year of Birth

*Player's First Name:

*Player's Last Name:

Sex of Player: Male; Female; check one

*Player's Date of Birth:: (month/day/year)

*Players Shirt Size:: Select one.

Week 1 (July 8 - 12): Junior Camp (born 2009-2012); Intermediate Camp (born 2006-2008); Senior Camp (born 2001-2005); Check one

Week 2 (July 15 - 19): Junior Camp (born 2009-2012); Intermediate Camp (born 2006-2008); Senior Camp (born 2001-2005); Check one

Week 3 (July 22 - July 26): Junior Camp (born 2009-2012); Intermediate Camp (born 2006-2008); Senior Camp (born 2001-2005); Check one.

Specialty Camps: Viper Jr. Boys Elite Development Camp (born 2006-2009 (requires approval); Viper Jr. Girls Elite Development Camp Born 2006-2009 (requires approval); Viper Sr. Boys Elite Development Camp (born 2001-2005) (requires approval); Viper Sr. Girls Elite Development Camp (born 2001-2005) (requires approval); .; Shooting Camp AM (born 2006-2009) (9:00 a.m. to 12:00 noon); Shooting Camp PM (born 2001-2005) (12:30 a.m. to 3:30 noon); Check one Viper Camp/Check one Shooting Camp

Viper Camp Approval: This player played on a KW Viper rep team in 2018-19; This player did not play on a KW Viper rep team in 2018-19. Approval has been given by the following coach:; Click to accept

Approval Coach:

*Waiver of Liability: ATTENTION: Please read the following very carefully before signing as it affects your legal rights. If the participant is under 18 years of age the following must be reviewed and approved by a parent/guardian. 1. That participating in this program may involve personal risk of damage or injury and Iagree to assume all such risk and hereby release the KW YBA and its employees and agents from all claims for damage or injury to my child that might result from his/her participation in the program save and except those damages and injuries caused solely by the negligence of the KW YBA, its employees, volunteers or agents. 2. That I will be solely responsible for making arrangements for the picking up of my child and will advise the KW YBA in writing if I have any concerns or there needs to be any special needs or arrangements. 3. That violation of the KW YBA’s Code of Conduct by my child my result in temporary or permanent banning from the program at the KW YBA’s discretion. By clicking on the check box, I acknowledge having read, understood and agreed to the above conditions, release and waiver.; Click to accept

(* indicates a required field.)

Office Use: Please leave empty

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