2024 Chenier-Wingfield Online Registration Form     
Basketball Camp at Wilde Lake High School
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Email *
Session (check all that apply) *
Session 1: July 22nd-July 26th
Session 2: July 29th-August 2nd
Both Sessions
Row 1
Participant's First Name *
Participant's Last Name *
Gender *
Birthday *
MM
/
DD
/
YYYY
Grade (last completed) *
T-Shirt Size *
Medical/Allergies/or Special Needs
Will you need before care (8am-9am)? *
Parent (Guardian) Name *
Address *
Emergency Contact 1 Name and Cell Phone # *
Emergency Contact 2 Name and Cell Phone # *
Payment
Camp Cost is $225 per camper per week.  Before care is an additonal $20 per camper per week.  Total amount due: *
Payment Method *
Liability and Release
I hereby register the above child as a participant in the basketball program.  I certify that I am the legal guardian of said child and hold harmless Wilde Lake, Wilde Lake Boosters, Phil Chenier , Deon Wingfield or Chenier-Wingfield Basketball Camp or staff from any and all liability or any injury, illness or condition that may arise as a result of participation in this program.  I also certify that the above child's birth date is accurate as indicated. In addition I give consent to release I hereby grant Chenier-Wingfiled Basketball Camp and Wilde Lake Boosters. permission to use my likeness in photographs, video recordings or electronic images in any and all of its publications, including website entries, without payment or any other consideration. I understand and agree that these materials will become the property of the organization and will not be returned. Additionally, I waive any right to royalties or other compensation arising or related to the use of my image. *
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