Which camp will you attend?

Which camp will you attend?*

Name*

First Last

Age*

Grade*

Address*

Street Address City ZIP Code

Mother's Cell #*

Father's Cell #*

Email Address*

Best Contact Number*

Permission (Parents Signature)*

______________has my permission to participate in the SCORE camp, I, as the undersigned, here by release and hold harmless the coaches, SCORE, and any associated sponsors from any and all claims and liability for personal injury arising from participate in all activites and authorize any neccessary medical, diagnostic/hospital procedure as may be performed or prescirbed by a licensed physician. I understand by submitting this form I am authorizing the minor to participate in the SCORE program.

Date

Parents Name

First Last

Physicians Name

First Last

Physicians Phone

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To Complete Registration Please Indicate if you are paying with cash or online. If paying online proceed to step 2 of the registration process at scorebball.com **Remember**As of August 1, 2013 we will no longer be accepting checks.

Name on Credit Card*

Credit Card #*

Expiration Date*

CVV*

Billing Zip Code*

Please solve this math problem:

Date

First Time Visitor

Register for a Score Basketball Camp