Second Wind Camp Registration Form - Midland, TX Dec 21-22

Welcome to the registration form for the 1st Annual Second Wind Hoops Basketball Camp presented by XConnect! Please, complete the form below to register for the December 21-22 Basketball Camp. We look forward to seeing you at the Diamondback Energy Athletic Complex!
PLAYER INFORMATION
Player First Name
Player Last Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Current Grade
School Attending
Gender

Other
PARENT/GUARDIAN INFORMATION
Parent/Guardian Name(s)
Relationship(s) to Player
Email Address
example@example.com
Guardian(s) Cell Phone Numbers
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Is the emergency contact listed above authorized to pick up your child from camp?
Please list any additional individuals authorized to pick up your child from camp. Please include their full name & relationship to the child.
MEDICAL INFORMATION
Does the participant have any allergies?
Does the participant have any medical conditions?
Additional Medical Notes
LIABILITY, MEDICAL, & ASSUMPTION OF RISK WAIVER
Please read and review the Liability, Risk, and Assumption Waiver below.
Please sign below to acknowledge and agree with the Liability, Risk, and Assumption Waiver.
Parent or Legal Guardian Signature
CODE OF CONDUCT
Please read and review our Code of Conduct.
REFUND & CANCELLATION POLICY
Please read and review our Refund & Cancellation Policy.
PHOTO AND VIDEO RELEASE
Do you authorize Second Wind Sports LLC to photograph or record your child during camp for promotional, educational, or social media purposes?
LET US KNOW!
What is your child’s t-shirt size?
How did you hear about Second Wind Basketball Camp?
PAYMENT

Future Stars | K-3rd Grade (9AM-12PM)

$129.00

All-Stars | 4th-8th Grade (1PM-4PM)

$129.00

Enter coupon

Total

Debit or Credit Card
Credit Card Number	Security Code
Expiration Month	Expiration Year

Should be Empty:

PLAYER INFORMATION

PARENT/GUARDIAN INFORMATION

MEDICAL INFORMATION

LIABILITY, MEDICAL, & ASSUMPTION OF RISK WAIVER

CODE OF CONDUCT

REFUND & CANCELLATION POLICY

PHOTO AND VIDEO RELEASE

LET US KNOW!

PAYMENT