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Camp registration

Waiver of liability and disclosure: I, the (parent/guardian) of camp participant will allow my child(ren) to participate in the activities at the Mark Jones Basketball Camp, knowing risk may occur. I hereby release and hold Mark Jones Basketball Camp, St. First Presbyterian Church, Wayne Densch YMCA,YMCA's, their coaches, employees and any other representative from claims relating to negligence while participating at the Mark Jones Basketball Camp. I further agree to release and hold harm-less from any loss, liability, damage or cost, including court and attorney fees, that may incur due to my child’s participation in camp activities whether caused by negligence of releases or otherwise.

Camper Full Name*

Your email Address*

School Attending*

Parent Full Name*

Parent Address*

Parent Contact Phone*

Emergency Contact Name*

Camp Date*

Insurance Carrier*

Enter Yes or No. I have read, understand and agree to the Waiver Acknowledgement above*

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