Overnight Camp at Brant Lake Registration

All fields with a * are required

* First Name

* Last Name

* Email

* Email Confirm

* Home Phone Number

* Street Address

* City

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* Zip

* Gender Male Female

* Date of Birth Please format like mm/dd/yyyy

* Fall School Grade k123456789101112

* Fall School Name

* Emergency Contact

* Emergency Phone Number

Roomate Requests optional, up to 8

* Camp Release Form Being the natural parent/legal guardian of the above-mentioned camper(s), I do consent to his/her participation in the Greg Koubek Basketball Camps. I know of no medical reason prohibiting my child from participating in the 2008 Greg Koubek Basketball Camps. I am aware that any exercise program, even moderate supervised exercise, bears some risk to the participant's health. I further agree that if he/she does suffer any injury, then the Greg Koubek Basketball Camp, Inc, The Brant Lake Camp, and Town of Clifton Park and The Recreation Department, through its employees, independent contractors, or agents, have my permission to sign any consent forms required to perform any necessary emergency medical treatment. I have made my child aware that physical activity will be occurring at the Greg Koubek Basketball Camp and that under no circumstances should they be exercising or playing if they feel light headed, or sick in any way, or have developed a cramp or injury. They will notify the staff of any allergies, sickness, or injury preventing them from continuing and subsequently rest. I understand that the camp hours outlined in brochure and/or webpage. I bear the responsibility of transporting my child to and from camp and I also understand that camp is not responsible for my child outside of camp hours. Furthermore, the camp accepts absolutely no responsibility for making sure an appropriate party picks up my child. I hereby release Greg Koubek Basketball Camps Inc, The Brant Lake Camp, the Town of Clifton Park and its recreation department or employees, agents or independent contractors of any liability and /or negligence claims resulting from my child’s participation in the Greg Koubek Basketball Camps.
I accept the terms outlined above in the Camp Release Form