Register: Simon Kenton Pioneers Basketball Camp

Camper 1

Simon Kenton Pioneers Basketball Camp

First Name *

Last Name *

Grade Entering *

Current School Attending *

T-Shirt Size *

Youth Small

Youth Medium

Youth Large

Adult Small

Adult Medium

Adult Large

AXL

Adult XL

A2XL

Adult 2XL

Multi-child discount: $105.00/camper when registering 2 or more!

Parent / Guardian

First Name *

Last Name *

Email *

Phone *

Address *

City *

State *

ZIP *

Emergency Contact

Someone other than parent/guardian if possible

First Name *

Last Name *

Phone *

Relationship *

Back

Camp Waiver & Parental Consent

Camp Waiver Parental Consent: My child (camper name will appear here) is physically/mentally fit to participate in Simon Kenton Pioneers Basketball Camp camp. I hereby release, covenant not to sue, discharge, and hold harmless the Kenton County School District, its Board members, and its employees, staff, agents and representatives, of and from liabilities, claims, actions, damages, costs or expenses incurred during camp participation. I consent to allow my child to receive medical treatment that may be deemed advisable in the event of injury, accident or illness.

I have read and agree to the camp waiver and parental consent *

Please type your name as agreement to consent *

Photo / Media Release

I grant Simon Kenton High School and its representatives permission to photograph, video record, and use the likeness of my child during camp activities for promotional materials, social media, website content, and other school-related publications. I understand that these images may be used without compensation and waive any right to inspect or approve the finished product.

I consent to the photo/media release for my child(ren) *

Registration Summary

Early Bird Discount (per camper) -$10.00

Convenience Fee (0.00%) $0.00

Total $115.00

Payment

Name on Card *

Card Details *