Registration Form
 
Camp Location :
Price :
$350.00
Camper’s Name
Phone :
Address :
City :
State :
Zip :
School Attend :
Grade in Fall :
Age :
Date of Birth :
T shirt size :
Parent/Guardian Name :
Relationship :
Home Phone :
Cell phone :
Work phone :
Email Address :
How did you hear about camp? :
Emergency name and phone number to be used in the event of an injury that requires emergency treatment  
Parent/Guardian :
Family Physician :
Phone :
Insurance Company :
Name on Policy :
Policy # :
Place of Employment :
Allergies :
Date of last Tetanus Shot :
Any medications or medical conditions that camp should be aware of :

I hereby certify that my son/daughter are in good health can participate in the RSOA Basketball Camp. I will not hold Crossroads School or RSOA responsible in the event of an accident or injury resulting from participation in the camp. I hereby give permission for my child to be given emergency treatment at a local hospital.

  I agree with Terms and Conditions.