Pay with Check – heimanbasketballcamp.com

Campers Name *

Parent's/Legal Guardians Name(s) *

Camp Attending (select one) *

Waitlist Open

Height *

Age *

Which package are you purchasing? *

Custom Shirt Size (select according to package you are purchasing. Select NA if no Add-ons) *

Custom Short Size (select according to package you are purchasing. Select NA if no Add-ons) *

Custom Hoodie Size (select according to package you are purchasing. Select NA if no Add-ons) *

Custom Jogger Size (select according to package you are purchasing. Select NA if no Add-ons) *

How many years playing organized basketball?

Past experience with the sport? *

School Enrolled in? *

Grade Entering in Fall 2023 *

Phone Number *

Parents Email *

Address *

City *

Zip *

Does the participant have Asthma *

Yes

Does the participant have any serious or severe allergies *

Yes

In case of an emergency, do you want the directors to seek medical care? *

Yes

Name of Physician and phone number

Any health or food problems we need to be aware of? (please list)

Who should we contact in case of an emergency (name and phone) *

I am aware that participation in the Heiman Basketball Camp has some inherent risks and injury can occur. On rare occasions these injuries can be serious. I also understand that participants of the Heiman Basketball Camp are often permitted to use the pool located on the premises, and that swimming also carries inherent risks and injury can occur. In consideration of my child being allowed to participate in the Heiman Basketball Camp, I, the parent/guardian, assume the risk of all injury and agree not to sue the Heiman Basketball Camp, the camp directors, coaches, assistant coaches, agents, or volunteers for any and all injuries caused by or resulting from participation in the Heiman Basketball Camp. By signing this waiver, I also authorize the use of pictures of the above-named participant to be posted on the Heiman Basketball Camp site or advertising media published by Heiman Basketball Camp *

I ACCEPT terms and conditions

Please type your full name followed by the date