In case of emergency (if there is no answer at above number):
Name and phone number of local person to contact:
Name __________________ Phone ( _____ ) _______________
Select each activity: Please use a separate form for each person
Private Basketball Skill Training Sessions (Times depend on Coach)
MondayTuesdayWednesdayThursdayFriday Saturday
Ballin' Ambassadors Basketball FALL Club/ League 2008
(September 9 - November 1 2008)
Check Age Group your child will be Sept. 1 2008
8-11 Club/ League 12-15 Club/ League
Ballin' Ambassadors Basketball CLUB/ League 2009
(April 21-June 19 2009) Practices Begin April 15
Check Age Group your child will be Dec. 31 2008 in:
10-11 Girls 10-11 Boys League 12-13 Girls League
12-13 Boys League 14-17 Boys League 14-17 Girls League
Ballin Ambassadors Basketball Camp 2K8
Check Camp Child will be participating in below:
Sunnyvale Middle School Location - (Camp Fee: $180)
June 23-27 July 21-25 August 4-8 August 11-15
Calvary Church Location -
(Full Day Camp Fee: $200) June 23-27 July 7-11 July 21-25
(Mini-Camp Fee: $95) June 23-27 July 7-11 July 14-18 July 21-25
July 28-Aug 1
(Mini-Camp Fee: $135) August 4-8 August 11-15
Red Morton Community Center Location -
(Full Day Camp Fee: $175June 23-27 July 21-25 August 4-8
Do you or your child have any special needs for this class or activity that we should know about?
Insurance Information
Each person is to have medical insurance provided by the parent or legal guardian. I, the undersigned parent or legal guardian, declare that my child has medical insurance.
Insurance Company / Program _________________ Policy Number ___________________
Emergency Authorization
I, the undersigned parent or legal guardian, hereby authorize the designated coach or church official acting as an activity supervisor, as my agent, to seek medical, surgical, or dental examination and treatment in the event of an injury.
Waiver of Liability and Disclaimer
I, the undersigned or parent/guardian of the individual named below do hereby agree to allow the individual named herein to participate in the aforementioned activity, and further agree to indemnify and hold harmless Fun Tyme Sports Academy/Ballin' Ambassadors, it's employees, volunteers, and other representatives from any claims arising out of or relating to any physical injury that may result from participation in this activity/activities. I/we agree to allow use of my/our likeness(es) for program publicity. I/we acknowledge that I have read the above information and understand its contents.
Circle appropriate information: Participant (over 18) Parent Legal Guardian
