Camp Registration

Registration Form

AGE: 9-14 YEAR OLD Dates: July 7 - 11th July 2025 TIME: 4pm-5:30pm WHERE: WILLETTON BASKETBALL STADIUM

"*" indicates required fields

Name*

First

Age*

Birthdate*

Gender*

Address*

Street Address City State / Province / Region ZIP / Postal Code

Phone Number

Mobile*

Email*

Parents Names*

Do you take any prescribed drugs?*

Today's Date

If Yes, for what condition

I hereby give permission for my child

Coach Details