Complete Player Camp Registration: Camper Information

Please fill out and submit this camper information form.

You may pay by check or by Visa or Mastercard.

If you are paying by check, please complete this application and submit it and mail your check to Complete Player Basketball Camps, P.O. Box 4597, North Hollywood, CA 91617.

If you are paying by credit card, please complete the credit card information at the end of this application.

Questions? Call us at 818-761-4891.

Contact information:

Camp Attending:

Please select the camp you are attending:

Camper's Name:

* required

Parent's Name:

* required

Street:

* required

City:

* required

State:

* required

ZIP:

Email:

* required

Home Phone:

* required

Cell Phone:

FAX:

Grade Completed 2009:

* required

Age at time of camp:

* required

School:

* required

T-shirt Size: (S,M,L,XL,XXL)

* required

Please note any medical conditions of which we should be aware:

Medical Insurance Company:

* required

ID #:

* required

I hearby authorize the staff of the Complete Player Basketball Camp to act for me in their best judgement in any emergency requiring medical attention, and I hereby waive and release the camp from any and all liability for injuries or illness incurred while in Camp. I understand that I am required to maintain and carry accident insurance coverage for the child listed on this application and I verify that the coverage information attached herewith is accurate and true. I also understand the Camp retains the right to use for publicity and advertising purposes photographs of campers taken at Camp.

Parent or Guardian - Please enter your name below to confirm
acceptance of above agreement:

* required

Please enter today's date:

___________________________________________________

Mailing Check

Paying On-Line by Credit Card ($5.00 Service Charge)

If paying by credit card, please enter your Visa or Mastercard number here:

Expiration Date:

Below, please enter the amount you are paying today by check or credit card. Remember to add $60 if you are ordering Gear-Up. Click the submit button at the bottom of the page to complete the sign-up process.

* required

Please click on the SUBMIT button below to send your application