CCSA 2018 Basketball Camp
July 30th - August 2nd
9:30am - 11:30am
Alamo City All Stars Sportsplex
11471 E Loop 1604 N, Universal City, TX 78148
Player Grade (2018-2019)
Parent/Guardian Phone Number
Address Line 2
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Bosnia and Herzegovina
British Indian Ocean Territory
Central African Republic
Democratic Republic of the Congo
Republic of the Congo
Papua New Guinea
Saint Kitts and Nevis
Saint Vincent and the Grenadines
Sao Tome and Principe
Trinidad and Tobago
United Arab Emirates
United States Minor Outlying Islands
Virgin Islands, British
Virgin Islands, U.S.
Does player attend Christ Church San Antonio?
How did you hear about our camp?
Emergency Contact Name
Emergency Contact Phone Number
Is there anything you think we need to know about your player? (allergies, health issues, etc?)
Names of those authorized to pick up your child. (Drivers License will be required.)
Please read the following waiver:
I have read understand and accept the Medical Authorization and Release Waiver below. Iunderstand that Christ Church San Antonio is a non-profit organization and that Christ Church cannot assume responsibility for losses, damages or injuries which may occur as a result of participation in this program. I understand that the student athlete and/or parent is responsible for damage done to any Christ Church property and the cost of repair and/or replacement of that property. In addition to the terms laid out above, I also accept the responsibility of insuring that my children understand and accept these policies and objectives. To the best of my knowledge, my child is physically fit for participation in this sport, and is neither seeing a physician for any sports injury nor being treated with any medication that may affect his or her performance.
MEDICAL AUTHORIZATION AND RELEASE: I do hereby release and hold harmless the directors, coaches, medical attendants, and adult leaders of the Christ Church Sports Program from any and all liability for all losses, damages or injuries occurring as a result of my child’s participation in the program’s activities. I further agree to make or cause to be made, by assignment of third party benefits or otherwise, full and complete payment for examination, treatment or hospital care required in the case of medical emergency. We understand that reasonable precautions will be taken to make the program safe and beneficial for all children, but that risk of injury cannot be eliminated entirely, and that this release is necessary for our child to participate in the Christ Church Sports Program. Furthermore, we hereby authorize, in the event our child suffers injury, any director, coach, medical attendant, or adult leader of the Christ Church Sports Program to consent to emergency medical treatment for our child when we cannot be contacted to so consent. Such medical treatment may include, without limitation, x-ray examination, anesthetic, medical diagnosis, treatment, or hospital care being required, and is given to provide authority and power on the part of a director or coach of the Christ Church Sports Program to give specific consent to any and all such examination, treatment, or surgical examination or treatment and general hospital care. No prior determination of life-threatening emergency or danger of serious or permanent injury resulting from delay of treatment need be made under this authorization. This authorization is given in advance of any specific hospital care.
Parent/Guardian name entered below indicates signature and acknowledgment of waiver.
Do Not Fill This Out