Berggren Hoop Camp

Camper Name

Address

City

Zip

Phone

Email Address

Grade

Gender

Male
Female

Date of Birth

Emergency Contact (other than guardian)

Phone Number of Emergency Contact

Consent form

I hereby give my consent for my child to participate in the Berggren Hoop Camp. I acknowledge participation in the game of basketball will involve risks that are unknown and uncontrollable. I knowingly agree to assume any and all risks associated with my child’s participation in the camp. In consideration of my child being permitted to participate in the camp, I, on behalf of the player, our family, and myself release and discharge Dream Out Loud Sports, LLC, Steamboat Middle Schoo, Aurora Turners Club, and their owners, directors, officers, trustees, employees and agents from any and all liability or responsibility for any injury that my child may sustain while participating in the camp. I acknowledge that the camp does not provide medical insurance for participants. In the event that my child is injured while participating in the camp, I authorize Dream Out Loud Sports, LLC, or its designated representatives, to administer medical treatment, as they deem necessary. I hereby accept full financial responsibility for the payment of all expenses related to such emergency medical treatment.I hereby give permission to Dream Out Loud Sports, LLC to use photographic likeness in all forms and media for advertising.

Parent/Guardian Name

Initial for consent

Camp session

June 6-9 9:00-12:00 Co-ed Incoming 1st-6th grades
June 26-29 9:00-12:00 Co-ed Incoming 1st-3rd grades
June 26-29 9:00-2:00 Co-ed Incoming 3rd-8th grades
July 31st-August 3rd 9:00-12:00 All Girls Camp Incoming 3rd-8th grades

T-shirt Size

Child Medium
Child Large
Adult Small
Adult Medium
Adult Large
Adult X-Large

Specific medical conditions or allergies

Yes
No

If yes, please explain

Payment Options:

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