2021 Summer Basketball Camp Registration
Please fill out the form completely.  If you are registering more than one child, please submit another form.

July 26th - 30th
Monday - Thursday 9AM - 3PM
$175 Per Participant (includes lunch and swimming each day)
Open to Boys and Girls Grades 1 - 9

For more information 570-574-1865 or junior.clutchbball@gmail.com
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Player Information
Player's First Name *
Player's Last Name *
Gender *
Grade *
Date of Birth *
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/
DD
/
YYYY
School *
Shirt Size *
Street Address *
City *
State *
Required
Zip *
Parent/Guardian Information
Parent/Guardian Name *
Parent/Guardian Phone *
Can receive text messages? *
Parent/Guardian #1 Email Address *
Emergency Contact Information
Other than the parent/guardian listed above.
Emergency Contact (other than above)
Emergency Contact Number (other than above)
Family Doctor
Hospital in case of Emergency
Special Request
Waiver
I , the parent/guardian of the registrant, a minor, do agree and will abide by all the rules of the Wyoming Valley Clutch LLC & Catholic Youth Center (CYC). l recognize the possibility of physical injury associated with participating in Wyoming Valley Clutch LLC & CYC sponsored activities, and in consideration for the Wyoming Valley Clutch LLC & CYC providing these activities, do release the Wyoming Valley Clutch LLC & CYC and its staff members from all liability for any injuries sustained while on CYC property and/or participating in CYC activities.
Waiver Acceptance
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