ACK HOOPS LLC
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*PLEASE
COMPLETE STEP 1
TO REGISTER CAMPER
*PLEASE
COMPLETE STEP 2
TO FINALIZE CAMPER SIGN-UP & CHECK-OUT
STEP 1 -
DAY CAMP SESSION 2 REGISTRATION
*
Indicates required field
DAY CAMP SESSION
*
SESSION 2 (GRADES 3-5)
CAMPER NAME
*
First
Last
GRADE (FALL 2020)
*
AGE
*
SCHOOL DISTRICT
*
PARENT/GUARDIAN
*
First
Last
Phone Number
*
PARENT/GUARDIAN
*
First
Last
Phone Number
*
Email
*
MEDICAL CONDITIONS
*
ALLERGIES
DIABETES
ASTHMA
EPILEPSY
OTHER*
PLEASE CHECK ALL THAT APPLY
*IF OTHER PLEASE DESCRIBE
*
CURRENT MEDICATIONS
*
PHYSICIAN'S NAME
*
First
Last
PHYSICIAN'S Phone Number
*
INSURANCE COMPANY
*
GROUP #
*
POLICY #
*
In the event of an injury, illness, and/or accident involving my child, I hereby give my consent for medical treatment and permission to a first responder to supervise on-site first aid, to the appropriate camp personnel to properly transport my child to an appropriate medical facility for care, and to a licensed physician to hospitalize and secure proper treatment (including injections, diagnostic procedures, anesthesia, surgery, and/or other reasonable and necessary procedures) for my child. I agree to assume any and all costs related to such treatment. I also authorize the disclosure of medical information to my insurance company for the purpose of any claim. I understand that each participant must provide his/her own medical insurance in order to participate in aforementioned participant's attendance and participation in the Hope College Camps Program. I also understand that registration is not considered complete until this completed form is on file.
I certify that my child has no injury or illness which could jeopardize his well-being by participating in the basketball activities of the Hope Basketball Camp.
PARENT/GUARDIAN CONSENT
*
AGREE
I agree to receiving marketing and promotional materials
Submit
*PLEASE
DO NOT REFRESH PAGE
AFTER SUBMITTING REGISTRATION
*PLEASE
COMPLETE STEP 2
TO CHECK-OUT
STEP 2 -
CHECK OUT
DAY CAMP SESSION 2 GRADES 3-5
$160.00
CHECK-OUT
QUESTIONS?
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