Ryan Martin Wheelchair Basketball

Basketball Camp Registration Form

Complete each field below and click on the "Submit" button
when completed. If you make a mistake just select the "Reset"
buttom to clear all the fields.

Please Note: You must check off the Parent Consent box on
the form in order to be allowed to submit your registration.

Athletes Name: Full Name

Age:

Date of Birth: day/month/year

Address: Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country

Phone Number:

Email:

Medical Condition:

Parental Consent

Parent Name 1: Full Name

Parent Name 2: Full Name

I hereby give conscent for my child to participate in the Ryan Martin
Basketball clinic. I agree to not hold Ryan Martin, clinic staff, or Nomad's
Adventure Quest responsible for any injuries or accidents that may occur.

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