Rising Stars Basketball

RISING STARS APPLICATION FORM AND EASY TRANSITION TO SHOPPING CART FOR PAYMENT AND CONFIRMED ENROLLMENT

After completing the application form below and selecting the correct event please click "submit form" at the bottom of this page to be automatically transfered to our shopping cart. REGISTRATION IS NOT COMPLETE until all information is filled out AND full deposit/tuition has been received (please select camp location and days your child is attending) and continue processing the order. Your child will then be fully registered and will receive an email confirmation directly upon payment.

YOU MUST COMPLETE THIS FORM, AND PAY FOR THE CAMP IN OUR SHOPPING CART TO BE REGISTERED FOR THE EVENT



Camper Name*
PLEASE PLACE THE PLAYERS PREFERRED NAME IN THE BOX BELOW.
DO NOT USE YOUR NAME
Players First Name:  

Players Last Name:

Age on Event Start Date*
Best Cell Phone Number*
(XXX) XXX-XXXX
If for some reason a player's parent or guardian is not present, we must be able to contact you in case of injury. We require a cell phone # where you may be reached at all times your child is unaccompanied. This number will be kept confidential and only used in an emergency.
Email Address*

We communicate with parents via email and text. If you do not recieve your confirmation email following payment, please check your SPAM/Junk Mail filter
Address*

Address Line 2
City*

Zip Code*

School Camper Attends*

   
Insurance Company*
Camper Gender*
Select an Event*
  

Waiver:

I hereby authorize the staff of Rising Stars Basketball Clinics, Inc. ("Rising Stars") to act for me according to their best judgment in any situation requiring medical attention for the person ("my child") participating in Rising Stars' activities ("camp") pursuant to this registration form. I hereby waive and release Rising Stars, its owners, employees, and agents from all liability related to or arising out of the participation of my child in camp, and I agree to accept responsibility for all medical expenses incurred related to or arising out of my child's participation. This waiver and release applies to all activities related to or arising out of my child's participation in camp, including, but not limited to, injury or illness occurring or contracted during camp. I know of no physical or mental condition that limits my child's ability to safely participate in camp. By initialing the box below and an signing this registration form, I confirm that I have read and understood this waiver and release.

By initialing in the box below I confirm that I have read and understand the above waiver

*

 
When you click on the "Submit Form" button you will be re-directed to the Shopping Cart where you pay for your child's registration - Thank You!!

Please do not hit the submit button more than once