Parent/Guardian Information

Name - Parent/Guardian:*

First

Last

Parent/Guardian Phone:*

Area Code

-

Phone Number

Parent/Guardian E-mail:*

Additional Emergency Contact:*

First

Last

Emergency Contact Phone:

Area Code

-

Phone Number

Church Affiliation:

Media Release: Do you give permission for your child(ren)’s photos to be taken and used on EPC website, social media, and other media publications?*

Yes

No

Camp Participants

6505- Please indicate how many Basketball Camp Participants you would like to register ($65/participant).*

1

2

3

4

Participant Name 1*

First

Last

Gender:*

Female

Male

Choose Grade Completed:*

Medical/Allergy Concerns:

Participant Name 2*

First

Last

Gender 2:*

Female

Male

Choose Grade Completed 2:*

Medical/Allergy Concerns 2:

Participant Name 3*

First

Last

Gender 3:*

Female

Male

Choose Grade Completed 3:*

Medical/Allergy Concerns 3:

Participant Name 4*

First

Last

Gender 4:*

Female

Male

Choose Grade Completed 4:*

Medical/Allergy Concerns 4:

Submission Information

By electronically submitting this form, I affirm that the child listed above has permission to attend the Basketball Camp and Easley Presbyterian Church, each staff, or camp staff will not be held responsible for accidental injury while attending camp.

Once you submit this form you will be directed to our PayPal page where you can pay with a credit card or your PayPal account. If you wish to pay by cash or check, simply close the page and please submit payment to Easley Presbyterian Church by mail or by dropping it off at the Church Office.

Total

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Basketball Camp

Basketball Camp

June 16 - June 19

June 16-19

9:00-11:45 am

K5-5th grades completed @ EPC Gym

$65/participant

Pay online or make checks payable to EPC.

Parent/Guardian Information

Camp Participants

Submission Information

Details

Organizer

Venue