Basketball Camp

Co-Ed Basketball Camp is July 15-19
9:30am to 10:30am for 5-11 year olds
11:30am to 12:30pm for 12-14 year olds
It's Free!!
Register online or in person at the church. Pre-registration is highly recommended.
Online registration is open until July 13th.
You can also print a flyer and bring it to the church completed.
If you have any questions feel free to contact the church at 260-747-5400.

basketball_flyer_2019.pdf
File Size:	290 kb
File Type:	pdf

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Basketball Registration

* Indicates required field

Child's Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Date of Birth (mm/dd/yyyy) *

Age *

Allergies *

Medical Conditions *

Medications presently taking *

Insurance info: Company Name *

Insurance Policy number *

Primary Insured Name *

Do we have permission to photograph your child? *

Yes No

Do we have permission to use your child's photograph for promotional purposes? *

Yes No

Home Phone Number *

Other Phone Number *

Emergency Contact Name *

First

Last

Emergency Relationship to Child *

Emergency Contact Phone Number *

My child has permission to particiapte in Kids Basketball Camp at Waynedale Baptist Church *

Yes

My child will be expected to obey the rules and the coaches at all times. *

Yes

Should a medical emergency arise, I give permission to the coaching/staff to secure medical attention for my child. *

Yes

My child would like a ride on the church van *

Yes No

Signature of Parent/Parents Name *

Email *

Submit