2008 Basketball Camp Registration

*Indicates a required field
 

Participant Information:

*First Name:
*Last Name:
*Gender:MaleFemale
*Grade for '07/'08 school year:
*Street Address:
*City:
*State:
*Zip Code:
*Home Phone:
*Church Affiliation, if any:
Are you interested in receiving information about other activities and ministries at Crossroads?
How did you hear about the Basketball Camp?
*T-shirt Size:
 

Family Information:

Parent / Guardian #1

*First Name:
*Last Name:
*Home Phone:
Cell Phone:
*Relationship:
 

Parent / Guardian #2

First Name:
Last Name:
Home Phone:
Cell Phone:
Relationship:
 

Emergency Information:

*Emergency Contact:
*Phone Number:
*Relationship:
*Family Physician:
*Phone Number:
 

Communication Information:

Due to the number of potential participants, necessary communications regarding the Basketball Camp are most effectively done via email. If you do not have an email address, please contact David Peters at (317) 485-2175 to arrange alternate communication.
*Email:
Additional Email:
 

Other Important Information:

*Please read the following information and check the box to indicate your agreement.
Notice: Crossroads Community Church does not provide health insurance coverage for participants in athletic activities at the church. Parents should provide such coverage, as Crossroads will not be responsible for any medical expenses arising from your child's participation in athletic activities at Crossroads.
As legal guardian of this registrant, I understand and hereby agree to assume all of the risks which may be encountered on the 2008 Crossroads Community Church Basketball Camp, including activities preliminary and subsequent thereto. I do hereby agree to hold Crossroads Community Church, its employees and volunteers, harmless from any and all liability, actions, causes of actions, claims, expenses, and damages on account of injury to my child, to me, or to my property, even injury resulting in death, which I now have or which may arise in the future in connection with the 2008 Crossroads Community Church Basketball Camp or participation in any other associated activities. In the event my child becomes injured or ill during any game or activity, I authorize the coach(es) or a representative of Crossroads Community Church to secure first aid and/or the services of a physician or hospital and agree to assume all financial obligations incurred therewith. I further release the coach(es) and all representatives of Crossroads Community Church from any liability, actions, causes of actions, claims, expenses, and damages with respect to the securing, or the failure to secure, such first aid or medical services in the event of my child's injury.