Camper's Information

Camper Name:*
Gender:*
Grade Level:*
Jersey Size:*
Any medical conditions: (If none, enter none below)*

Parent/Guardian's Information

Name:*
E-mail:*
Phone:*
-
Are you currently attending Silicon Valley Alliance Church?*
Are you willing to help out as assistant coach?
Would you like us to contact you for the future programs/activities?

Waiver of Liability Release Form

I, the undersigned, parents/guardian of (Enter name of your child below)*
do agree to release and hold Silicon Valley Alliance Church (SVAC) and its staff and coaches harmless from any claim, demand or cause of action for injury to the above named participant of SVAC’s Basketball Camp programs or damage to his or her personal property which arises out of or is in any way connected with the programs of SVAC. SVAC will not be responsible in case of accident, illness or property damage. I also authorize SVAC to put my child under the treatment when my child is in medical need. I also agree that my child be treated by any licensed physician. I also understand SVAC may photograph or videotape the events or activities in which I am (or my child is) participating. I give my permission for SVAC to use photographs or videotape of me (or my child) for the purpose of promoting its services/programs. I give my permission with the following understanding: No compensation of any kind will be paid to me (or my child) at the time or in the future for the use of my (or my child’s) likeness, i.e. your child's name on the video.
Agree with the above waiver of liability terms:
Print your name here as the signature:*
Silicon Valley Alliance Church is committed to protecting your privacy and does not share your personal information with third parties. For further information, see Silicon Valley Alliance Church Privacy Policy.
Amount:*
 $ 
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