2026 Camp

Participant Waiver & Release

Complete and submit this waiver for each camper before the first day of camp. All fields are required.

Event

CBA Basketball Camp 2026

Date

August 29, 2026

Location

Northside Christian High School, Rock Hill, SC

1Participant Information

Camper Full Name *

Date of Birth *

Age *

Grade *

School *

2Emergency Contact

Emergency Contact Name *

Relationship *

Primary Phone *

Alternate Phone

3Medical Information

Physician Name

Physician Phone

Allergies (food, medication, environmental — write "None" if none)

Current Medications (write "None" if none)

Medical Conditions or Physical Limitations (write "None" if none)

Health Insurance Carrier

Policy / Member Number

4Liability Release & Waiver

In consideration of my child's participation in the Carolina Basketball Association (CBA4Youth) Basketball Camp, I, the undersigned parent or legal guardian, hereby release, waive, discharge, and covenant not to sue CBA4Youth, its officers, directors, coaches, volunteers, employees, and agents (collectively "Released Parties") from any and all liability, claims, demands, actions, and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by my child while participating in this camp or while on the premises where the camp is being conducted. I acknowledge that participation in basketball activities involves inherent risks of injury, and I voluntarily assume all such risks on behalf of my child. I further agree to indemnify and hold harmless the Released Parties from any loss, liability, damage, or costs they may incur due to my child's participation in this camp. I certify that my child is physically fit and has no medical conditions that would prevent safe participation, except as noted in the medical information section below. I authorize CBA4Youth staff to obtain emergency medical treatment for my child if I cannot be reached.

I have read, understand, and agree to the Liability Release & Waiver above on behalf of my child. I am the parent or legal guardian of the participant named in this form. *

5Photo & Media Release

I grant CBA4Youth permission to photograph and/or video record my child during camp activities. These images and recordings may be used for promotional, educational, and social media purposes without compensation. I understand I may opt out by checking the box below.

I opt out of the photo and media release — do not photograph or record my child.

6Parent / Guardian Signature

Parent / Guardian Full Name *

Relationship to Camper *

Phone Number *

Email Address *

Date of Signature *

By typing your name and submitting this form, you are providing a legally binding electronic signature.

Questions? Contact Don Kesterson at [email protected] or 304-482-8080.