The Ray Robinson Oak Park Community Centers 2022 Youth Basketball Camp
2022 Youth Camp Offers: Indoor Facility Developmental In Shooting, Passing, etc. Volunteer Coaching Staff 4 Days of Drills Ages 8 – 14 yrs. old **LIMITED SPACES AVAILABLE** Registration Starts: Camp Runs: Divisions
MAY 6, 2022
8 – 14 Years Old - Basketball
June 6th – June 9th
Monday - Thursday
Camp Times: 6:00pm - 7:00pm
Child plays in division based upon their age on or before Registration Day All players must provide a copy of birth certificate. **We now accept Credit Card, Debit Card, Cash and Money Orders**
The Salvation Army Ray Robinson Oak Park Community Center (916) 469-4620 2540 Alhambra Blvd Sacramento, CA 95817 Our campus is DRUG, ALCOHOL & WEAPON FREE.
THE SALVATION ARMY RAY ROBINSON OAK PARK COMMUNITY CENTER
2022 Basketball Camp for Boys & Girls $50.00 Per - Player (8-14 years old) 2022 Youth Sports Registration PARTICIPANT INFORMATION Divisions Circle One
__Basketball
8 – 14 yrs. Old ________
Participant’s Full Name
Complete Address
Date of Birth
City
State
Zip code
Email Address
PARENT/GUARDIAN INFORMATION Parent/Guardian name
Home Phone
Cell Phone
Emergency contact name (1)
Relationship
Phone
Emergency contact name (2)
Relationship
Phone
MEDICAL INSURANCE COVERAGE/TREATMENT INFORMATION Insurance Carrier/ Policy Number
Phone
Doctor’s Name
List any History of Allergies List Regular Medication Taken List any other Medical Conditions (physical/medical limitations) I hereby authorize my son/daughter to participate in The Salvation Army’s Youth Program. As the legal guardian of the above-named child, I agree to relieve The Salvation Army or its directors, officers, employees, agents, or other representatives from all liability in connection with any loss, damage, or injury arising in connection with my son/daughter’s participation in this program. I further agree to the regulations, conditions, and policies of The Salvation Army’s program and accept full financial and legal responsibility for the conduct of my son/daughter. I hereby authorize the administrators of this program reasonable and necessary emergency medical treatment for my son/daughter while he/she is participating in the program. I further agree to pay for any such reasonable and necessary medical treatment upon presentation of the medical provider’s bill or statement. I also understand that there are NO REFUNDS.
Parent/Guardian Name- Please Print ______________________ Parent/Guardian Signature
______________________
The Salvation Army
Date
Ray Robinson Oak Park Community Center ---Player Photo Release--I hereby grant The Salvation Army the absolute right and permission to copyright and/or publish or use photographic portraits or pictures of my child ______________________________, in which he/she may be included in whole or part, or composite or distorted in character or form, in conjunction with his/her name or a fictitious name, or reproductions thereof in color or otherwise, made through any media, for art, advertising, or any other lawful purpose whatsoever. I also grant The Salvation Army the same right and permission to use any statement or testimonials made by myself or my child. _____________________________ Parent/Guardian Name
_____________________________ Parent/Guardian Signature
_________ Date
--- Parent Code of Conduct, (Please Read) -- I will encourage good sportsmanship by demonstrating positive support for all players, coaches, and Staff at all Salvation Army functions. I will place the emotional, physical, and educational well-being of all players ahead of any personal desire to win. I will remember that the game is for youth and that this Camp is focused on developing players in a positive and safe environment. I will ask my child/children to treat other players, coaches, fans, and staff with respect regardless of race, sex, creed, or ability and will not tolerate bullying or harassment of any kind. I understand that there will not be carpools with coaches to the Camp. It is my responsibility to get my child to and from The Salvation Army. I understand that my child MUST be accompanied by an adult, or the authorities will be notified. I will, always, remember that The Salvation Army is a Christian organization and that my family, guest(s) and I will conduct ourselves accordingly to this belief. I will handle all disagreements in a respectful manner and understand that anyone who fails to comply with this code of conduct and/or the posted gym rules may be asked to leave the facility. _____________________________ Parent/Guardian Name
_____________________________ Parent/Guardian Signature
____________ Date
Covid -19 I understand that in participating in recreational activities offered by The Salvation Army, my child(ren) might be exposed to infectious diseases, including but not limited to Covid-19 or SARS-COV-2. As a parent/guardian, I hereby expressly and specifically assume the risk of injury or harm that may come to my child(ren) in these activities and release The Salvation Army from all liability for injury, illness, death or property damage resulting from the activities of my participation with The Salvation Army.
Parent Signature: ____________________
Date: __________
C.C. Coordinator: ____________________