Collegiate Prep Basketball Academy Form

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All Saints Elementary Camp 2012

Last Name:
First Name:
Birthday:
Age:
Camp Shirt Size:
Address:
City:
State:	Zip:
Phone Number:
School:
Grade:
Gender:
Parent's Name:
Parent's Email:
Alternate Email:
Alternate Email 2:
Cell Phone:	Cell Phone 2:
Insurance Company:
Insurance Policy Number:
Medical Concerns (if any):
Emergency Contact Name:
Phone:
Relationship:

I give my son/daughter permission to participate in the All Saints Elementary Camp Program.

I hereby grant permission to Collegiate Prep Basketball Academy to have my child treated by a physician if necessary and waive any and all liability or any costs associated from any injuries that may occur involved with the participation of camp.

I agree to allow Collegiate Prep Basketball Academy to use my child’s photograph and likeness on any website, brochures, or other promotional materials.

By submitting this form, I agree to the waiver and liability clauses. This has legal standing as if it where your signature.

I agree to the above statements

I am the parent/legal guardian of , who is, with my permission, a "Participant" in Collegiate Prep Basketball Academy's Little Hoopsters Camp
On behalf of the Participant, the Participant's parents, and/or legal guardians, I hereby give approval of the above-named Participant's participation in any and all programs and activities sponsored or provided by Collegiate Prep Basketball in connection with their use of All Saints Church facilities, and do hereby waive, release, absolve, forever discharge, and agree to hold harmless and without limitation, All Saints Church, and all their respective employees, from, and against any claim or cause of action of any nature whatsoever that may be available to the Participant or his/her parents and/or legal guardians, arising out of any injury, accident or illness to the Participant, arising in any way out of or in connection with the Participant's participation in such programs and activities.

I agree and sign to the above waiver

All basketball information is proprietary and protected by US copyright laws. Any attempt to steal, copy, duplicate, disseminate, distribute transfer or reproduce copyrighted ideas, terms, drills, organizational materials or other league or instructional information for monetary gain or in competition of the CPBA is a direct violation of US law and subject to prosecution under the law. This includes coaches, camp directors, parents, or player representatives/agents recruiting players for the direct purpose of creating their own teams, training programs, camps, etc.

In registering my child I fully understand and agree to the above terms.

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