Murphy's Basketball Camp

Registration Form

This registration form collects essential information to ensure a smooth and safe experience for all participants. Please provide the following details:

Participant Information: Name, birth date, gender, and contact details.
Parent/Guardian Details: Provide parent/guardian name and contact information for minors.
Emergency Contact: Name and contact details of someone we can reach in case of emergencies.
Medical Information: List any medical conditions, allergies, or special needs to help us provide proper care.
Consent and Acknowledgment: Review and agree to the consent section, including medical release and authorization.

Make sure all information is accurate and complete. If you have questions or need assistance, please contact us directly.

Athlete's Name

Participant Name

Parent/Guardian Contact Phone

Enter Parent/Guardian Contact Phone

Age

Select Age of Athlete

Birth Month

Select birth month of athlete

Birth Day

Select birth day of athlete

Birth Year

Select Birth Year

Address

Enter Address include street, city, state and zip code

Parent/Guardian Name (for minors under age 18)

Enter first and last name of parent or guardian

Enter email for communication

Emergency Contact Relationship

Emergency Contact's Name

Enter emergency contact first and last name

Emergency Contact Phone

Enter phone number for Emergency Contact

Does the athlete have any allergies, chronic illness, or medical conditions? If yes, please describe.

Is the athlete prescribed an inhaler? If yes, please explain any instructions.

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Murphy’s Basketball Camp during the selected camp. In exchange for the acceptance of said child’s candidacy by Murphy’s Basketball Camp, I assume all risks and hazards incidental to the conduct of the activities and release, absolve, and hold harmless Murphy’s Basketball Camp and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions. In case of injury to said child, I hereby waive all claims against Murphy’s Basketball Camp, including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including basketball. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.

Medical Release and Authorization

As Parent and/or Guardian of the named athlete, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional of the minor child in the event of a medical emergency, which, in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed. Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination, and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that the attending physician will make every attempt to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me. Permission is also granted to the Murphy’s Basketball Camp and its affiliates, including Directors, Coaches, and Team Parents, to provide the needed emergency treatment prior to the child’s admission to the medical facility. Release authorized on the dates and/or duration of the registered season. This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances for the protection of the life and limb of the named minor child in my absence.

Confirmation

Enter First and Last Name to Confirm