Valley Jewish Community Center

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Basketball Camp Registration

Please fill in the form below for each child you would like to register for the Wayne Youth Basketball camp.

If you sign up for multiple sessions/weeks or a sibling, a 10% discount on each additional sessions/weeks or siblings will be applied later. 

"*" indicates required fields

Name*
MM slash DD slash YYYY
Parent 1 Name*
Parent 2 Name
Primary Policy Holder Name*
Emergency Contact Name*
Please select which options you would like to register for.
Hidden
Session Choices
Week 1 - July 11 - 15 @ A.E. Wright
Week 2 - July 18 - 22 @ A.E. Wright
Week 3 - August 8-12 @ Emek
Week 4 - August 15-19 @ Emek
Price: $0.00
Includes selections above and a 3% processing fee.
Credit Card
American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Expiration Date
 
Billing Address*
PARENT PERMISSION FORM, LIABILITY WAIVER AND RELEASE, AND AUTHORIZATION FOR MEDICAL/DENTAL TREATMENT I understand that participation in the VJCC/Eclipse basketball camp involves risk and dangers of serious and permanent bodily injury and death. I hereby release, hold harmless, discharge and agree not to sue Eclipse basketball, Ben Yeger, the VJCC, all their affiliates and DBA, all directors, officers, employees, coaches, officials, volunteers, owners/leasers of premises for and from all liability from my participation in and with these and any other related travel, lodging, social and recreational activities. I also understand Eclipse basketball retains the right to use for publicity and advertising, photographs and video taken of the participants. I have given my son/daughter permission to participate in the VJCC/Eclipse Basketball events, and I certify that he is in good health, has been cleared by a physician and can take part in all physical activities not limited to, but including training, practices, and games. I am aware that my son/daughter may become injured. If an injury occurs, I authorize the staff members to take any action and use the emergency service available at the nearest hospital if necessary. I understand my personal insurance will be used in this case. In case of an emergency, I authorize the personnel to take action.
Name*
By typing your name below you are indicating you have read the above Parent Permission form, liability waiver, and release.
Medical Release**
Player Name*
By typing your name below you are indicating you have read the above Parent Permission form, liability waiver, and release.
Parents Code of Conduct**
Waiver**

Please click the submit button only once to avoid duplicate charges / submissions. Sometimes it takes a minute or two to process.
This field is for validation purposes and should be left unchanged.