2023 Crossover Registration Form (One applicant per form)

Location: New Day Christian Church

Dates:
July 11th-14th (Rising 3rd-5th grades)
July 18th-21st (Rising 6th-8th grades)

Time: 9:00am-2:00pm Tuesday-Friday (both camps)

Registration deadline: Friday, June 16, 2023

Rather mail your application and payment? Use this link to access a blank application 16th annual Crossover Basketball Camp

Please note that we have a registration limit of 60 children per camp. Once registration reaches full capacity, registration will be closed and all incoming registration forms (in person, online and via mail) will be placed on a waiting list.

Parent or Guardian Information

Parent or Guardian's Name:

Address

Cell Phone:

Home Phone:

Email address:

This address will receive a confirmation email

Home Church

Other Information

Emergency Contact Name (other than parent)

Emergency Contact Phone:

Name(s) of person(s) who may pick up child from camp:

Camper's Information

Camper's Name:

Age:

Gender:

Grade (2023-2024 school year):

School:

T-shirt size:

Does your child have food, drug or seasonal allergies? If yes, please describe. If no, enter N/A.

Does your child have a physical condition that would affect his/her activity level? If yes, please describe. If no, enter N/A.

Camp Selection (use 2023-2024 grade level)

Choose one:

Insurance Information

Each person is to have medical insurance provided by the parent or legal guardian. I, the undersigned parent or legal guardian, declare that my child has medical insurance.

Insurance provider:

Policy Number:

Emergency Authorization

I, the undersigned parent or legal guardian, hereby authorize the designated coach or church official acting as an activity supervisor, as my agent, to seek medical, surgical, or dental examination and treatment in the event of an injury.

Waiver of Liability and Disclaimer

I, the undersigned parent/guardian of the individual named in the Camper's Information section do hereby agree to allow the individual named herein to participate in the aforementioned activity, and further agree to indemnify and hold harmless New Day Christian Church, its employees, volunteers and other representatives from any claims arising out of or relating to any physical injury that may result from participation in this activity/activities. I/we agree to allow use of my/our camper's likeness for program publicity. I/we acknowledge that I/we have read the above information and its contents.

Authorization

*By entering my name in the box below, I am indicating the provided information is accurate and I am providing my digital signature on this form.

Electronic Signature*

Date

PAY NOW

Camp registration is $65.00 per child.

Payment $65.00

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

2023 Crossover Registration Form (One applicant per form)

Description

Please Fix the Following