GSL Baskeball Camp Registration Form 2017

2016 V G.S.L. Basketball Camp

 

Name: __________________________________________________________

 

Address: ________________________________________________________

 

City:   ____________________   State: ________     Zip: ______

 

E-Mail: _________________________________________________________

 

Grade: _______________           Date of Birth: ________________

 

T-Shirt Size

S _____                 M _____                 L _____                 XL _____

 

Indicate which camp you are registering for:

          _____          AM Session Camp – August 1st - 4th                  $70.00

                             (Boys and girls 3rd - 6th grade) 9:00am – 12:00pm

      *finishing 2nd going into 3rd grade

          _____          PM Session Camp – August 1st - 4th                  $70.00

                             (Boys and girls 7th - 12th grade) 1:00pm - 4:00pm

 

 

Emergency Contact:

 

Name: __________________________________________________________

 

Home Phone: ____________________ Cell Phone: ______________________

 

Medical conditions:

 

________________________________________________________________

 

Waiver Agreement

I grant permission to the staff of the G.S.L. Basketball Camp to act on my behalf of my child in granting permission for evaluation/treatment of minor medical problems.  I understand that should a major medical problem arise, an attempt will be made to notify me by telephone.  In the event I cannot be reached, I hereby give my consent to such medical treatment as deemed necessary by a licensed physician.  In addition, I hereby release the G.S.L. Basketball Camp, its employees and agents from all claims on account of any injuries, which may be sustained by my child while traveling to, participating in and returning from the camp.  I also agree to indemnify the G.S.L. Basketball Camp, its employees and agents from any claim, which may hereafter be presented by my minor child as a result of illness, or accident while my child is at the G.S.L. Basketball Camp.

 

___________________________________________           ________________

Parent/Guardian Signature                                                 Date

 

          PLEASE RETURN THIS FORM WITH YOUR FULL PAYMENT TO:

 

  • Gerard Gallegos 1000 East Fairclough Drive Salt Lake City, Utah 84106
  • Please make checks payable to “Gerard Gallegos Basketball Camp
  • Same day registration will be accepted 8:00 a.m.–9:00 a.m. and 12:00 p.m.–1:00 p.m.

 

QUESTIONS: Please call or e-mail Coach Gerard Gallegos

 (gerard100@comcast.net) or (gslbasketball@hotmail.com)

   801-647-2829 or 801-484-5470