Back to the Basket Camp Registration and Release Form
Please complete this form and payment to participate in the camp. Thank you!
Participant Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Parent/Guardian Full Name
*
First Name
Last Name
Email
*
example@example.com
Emergency Contact Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name (if different from Parent/Guardian)
First Name
Last Name
Medical Conditions or Allergies
*
I, the undersigned, release Back to the Basket from any liability during the camp.
*
I consent to the participant being photographed/filmed for promotional use
*
Signature of Parent/Guardian
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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Next
Age
*
School Grade
*
Shirt Size
*
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult XL
Dietary Restrictions
*
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Submit
Submit
My Products
*
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Back to the Basket Camp Registration
August 8 + 9
$199.00
$
199.00
Quantity
1
2
3
4
5
6
7
8
9
10
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Google Pay
After submitting the form, you will be redirected to Google Pay to complete the payment.
Cash App Pay
After submitting the form, you will be redirected to Cash App Pay to complete the payment.
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