North Cobb Warrior Basketball Camp Registration Form

Camper's Name:

 First Name:   Last Name: 
Gender: Male
Camp: Warriors
Camper's Date of Birth: Month:   Day:   Year: 
Camper's Age:
Camp Session:

Parent's / Guardian's Name:

 First Name:   Last Name: 
Street Address:
P. O. Box or Apt#:
City:
State:
Zip Code:
Email Address for Confirmation:
Home Phone:
Emergency Phone:
Medical Waiver: (Please read carefully, enter your full name then select "Yes" or "No" in field labeled: "I Agree to the Above Medical Waiver:")
STATEMENT: I recognize there are inherent risks involved in this sport activity. In consideration of the services provided, I hereby release and hold harmless Warrior Basketball Camp, North Cobb Tip Off Club, and its director, employees and agents from any and all liability for injuries, including those resulting in death, and illnesses incurred while attending camp or occurring as a result of having attended camp. I certify that my child is in good health and is able to participate in all program activities. Furthermore, in the event of an emergency requiring medical attention, I shall pay for the services rendered. I hereby authorize medical treatment for my child.
Full Name of Parent / Guardian
Accepting this Medical Waiver:
I Agree to the Above Medical Waiver:
T-Shirt Size:
School (2009/2010):
Grade (2009/2010):