Little Heroes Foundation : Little Heroes Foundation

Camper Information

Camper's First Name ^*

Camper's Last Name ^*

Camper's Age ^*

Camper's Height ^*

Grade ^*

Shirt Size ^*

Parent & Emergency Information

Parent/Guardian Name ^*

Phone ^*

Email ^*

Emergency Contact ^*

Phone ^*

Age Groups

Groups based on your child's grade at the beginning of the fall 2012 school year.

Group 1: Grades 1-4 9:00-11:00am 127 positions left

Group 2: Grades 5-10 11:00-1:00pm 128 positions left

Terms and Conditions

Physical Condition of Participants

To ensure all campers meet the physical requirements, the Little Heroes Foundation require that a parent or guardian of the registered participant provide their signature below authorizing that your child is free from conditions that would cause them harm during strenuous physical activity. If your child has such a condition, please be informed that you will need a doctor's signature certifying that your child is healthy and ready to participate.

Refund Policy

Your registration fee includes a $25.00 non-refundable deposit. The remainder of the fee is refundable up until July 1, 2012. Please send requests by phone or email @ 801.377.1423 or info@herowithin.org.

Allergies

Please indicate in the space provided if your child has any allergies that would limit participation.

Does your child have asthma?

Yes No

If yes, please explain the circumstances that would allow your child to safely participate.

Other limiting physical conditions.

Little Heroes Foundation Liability Form

I am aware that my child(s) participation in the Little Heroes Charity Basketball Camp brought to you by the Little Heroes Foundation has dangers and risks, inherent to the game of basketball and additional dangers and risks, including, but not limited to, the danger and risk of collision and forceful bodily contact with other players, the playing surface, walls, balls, benches and doorways, and other items present in the gym, accidental or otherwise.
I freely accept and fully assume all such dangers and risks and the possibility of personal injury, death, property damage or loss resulting there from/for my child(s).
The use of mouth guards is highly recommended for all participants.
By signing this form I hereby acknowledge that the Little Heroes Foundation, coaches, representatives and volunteers are not liable to any of the spoken above.
I do hereby grant permission to Little Heroes Foundation to use my child(s) name, voice, statements, photograph, image in likeness to reference of the Little Heroes Charity Basketball Camp.

THE PARENT/LEGAL GUARDIAN IS RESPONSIBLE FOR THE MEDICAL COVERAGE FOR THE CHILD THEY REPRESENT.

General Rules

My child / camper hereby promises to obey all rules, regulations and code of conduct of the Little Heroes Foundation.
Little Heroes Foundation will not be liable for any injuries received while my child/camper is playing or for loss of or damage to equipment.

Entering your name below shall represent a legal signature

Parent or Guardian Signature ^*

Please direct any questions or comments to the Little Heroes Foundation @ 801.377.1423 or info@herowithin.org.