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VES Basketball Academy
Winter Day Camp Registration

Required

Will the player attend all four Winter Clinics?required
Dates Attending required
Parent's Namerequired
First Name
Last Name
Player's Namerequired
First Name
Last Name
Player's Genderrequired

Each child is required to have accident and/or health insurance. Please provide coverage information below.

My child requires distribution of medication during the camp day.required
Certain needs of my child require special attention.required
My child has a prior injury that could restrict the amount and type of activity.required
$100.00

By submitting this application, I agree that, in the event my child requires medical attention or treatment of any kind during participation in any VES Camp/Clinic, I hereby authorize any employee, director, or representative of the Camp/Clinic to take any and all actions that they, in their sole judgment at the time, deem to be reasonable to render aid to my children.

By submitting this application, I, for ourselves, our heirs, executors, and administrators, waive, release and forever discharge the training staff, officers, agents, employees, representatives, successors, and assign of and from all rights and claims for damages, injuries, or loss of person or property, which may be sustained or occur during participation of camp activities, whether or not damages, injury, or loss is due to negligence.
Must contain a date in M/D/YYYY format

Payment Information

Please complete captcha below to proceed to payment selection.

Please select a payment typerequired
Billing Addressrequired
Cardholder Namerequired