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Basketball Registration Form

Register up to three kids in the same family

Student's name
Male Female

Date of Birth (mm-dd-yyyy)

Session

Medical Information
Does your child have any medical concerns that we need to be aware of (asthma, allergies, diabetes, etc)?
Yes No

If yes, please explain

2nd student's name
Male Female

Date of Birth (mm-dd-yyyy)

Session

Medical Information
Does your child have any medical concerns that we need to be aware of (asthma, allergies, diabetes, etc)?
Yes No

If yes, please explain

3rd student's name
Male Female

Date of Birth (mm-dd-yyyy)

Session

Medical Information
Does your child have any medical concerns that we need to be aware of (asthma, allergies, diabetes, etc)?
Yes No

If yes, please explain

Parent's name (required)

Street Address

City

State

Zip code

Parent's email (required)

Primary phone (required)

Work phone

Secondary phone

Emergency contact

Relationship

Phone

For your records. . .

Camp Olympia Basketball sessions are 8 weeks long.
Payments are due every 8 weeks

All fees are payable to Camp Olympia 7304 5th Ave, # 271 Brooklyn, NY 11209