Clone of Fall Break Basketball Camp

1
Camp Attending
9am - 12pm (Doors Open at 8)
1PM - 4PM ELITE CAMP (Doors Open at 12:30
Both
2
Late pickup? (Up to 2 hours after camp ends)
YESNO
3
Athlete 1* This field is required.
First Name
Last Name
4
Athlete 2
First Name
Last Name
5
Best Contact Email* This field is required.
example@example.com
6
Best Contact Phone (Call/Text)* This field is required.
Please enter a valid phone number.
7
Grade Level* This field is required.
Please Select
Please Select
7th-8th
5th - 6th
3rd - 4th
K -2nd
8
School* This field is required.
9
T-Shirt Size Athlete 1* This field is required.
Please Select
Please Select
YS
YM
YL
AS
AM
AL
AXL
10
T-Shirt Size Athlete 2* This field is required.
Please Select
Please Select
YS
YM
YL
AS
AM
AL
AXL
11
Parents Name* This field is required.
12
How did you hear about the basketball camp?* This field is required.
Social Media
Friend/Family
Flyer
Website
13
Playing experience* This field is required.
AAU
Basketball Leagues (FBBA, New Territory)
Basketball Camps Only
None
14
🔹 Acknowledgment of Risk* This field is required.
I, the undersigned parent/guardian, acknowledge that participation in basketball activities, practices, training sessions, games, and related events with H-Town Supreme Fall Ball League (Lead Through Athletics) at 4 Quarters Gym involves risks, including but not limited to: falls, collisions, physical contact, sprains, broken bones, and other injuries. I understand these risks are inherent to the sport and cannot be eliminated.
I do not agree
15
🔹 Waiver & Release* This field is required.
In consideration of my child’s participation, I hereby release, waive, and discharge H-Town Supreme Fall Ball League, Lead Through Athletics, 4 Quarters Gym, coaches, staff, volunteers, and affiliates from any and all liability, claims, or demands for personal injury, property damage, or wrongful death arising from participation in league activities, whether caused by negligence or otherwise.
I do not agree
16
🔹 Medical Treatment Authorization* This field is required.
I authorize Lead Through Athletics and 4 Quarters Gym staff/volunteers to seek emergency medical treatment for my child in the event of injury or illness. I agree to be responsible for any associated costs.
I do not authorize
17
🔹 Insurance Responsibility
I understand that Lead Through Athletics and 4 Quarters Gym do not provide medical insurance for participants and that it is my responsibility to carry appropriate coverage for my child.
18
Parent/Guardian Signature
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19
Any additional comments or needs we should know about?* This field is required.
20
Date Signed
Date
Month
Day
Year
21
Are you or do you have any company interested in donating to Lead Through Athletics? (We are a 501c3 nonprofit organization.)* This field is required.
Yes
No
22
My Products* This field is required.
prevnext( X )
My Bag
0
My Bag
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
ORDER SUMMARY
Total costUSD
Thanksgiving Day Camp Registration
$130.00Edit
Back
1
1
2
3
Quantity
Late Pick UpLate pickup is 3pm. Please have a lunch provided for your child.
$20.00Edit
Back
1
1
2
3
4
5
6
7
8
9
10
Quantity
Single Day Drop In
$50.00Edit
Back
Monday
Monday
Tuesday
Wednesday
Single Day Selector
Total cost $0.00
23
Payment Methods
Debit Or Credit Card
Select PayPal Method
Choose from one of the PayPal options to make your payment.
Buy with
Buy with
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