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Basketball Camp Registration

2015 Summer Basketball Camp (August 3-7)

Please complete the following registration and join us for an exciting week of camp at Girls Place!
  • Membership

    Membership is a one time annual fee that is required to participate in any Girls Place program. Membership fees are $20 for one child and $40 for families with two or more girls participating. Membership is nonrefundable and nontransferable. Girls who have participated in after school, athletics and summer camp in 2015 have already paid their membership fees. New members will be assessed membership when they register for the summer volleyball camp. Please call (352) 373-4475 if you would like to verify that your membership is paid.
  • Summer Basketball Camp Fee

    The summer basketball camp fee is $130. An active 2015 Girls Place membership is required to participate.
  • Hours

    Children may be dropped off between 7:30am-9am. During that time frame, each child will be placed in an age appropriate group with the regular summer campers. At 9am, the children who are signed up for the sports camp will be called to the gym to begin skill work. The summer basketball camp will end at 5pm after which girls will be placed in their age appropriate group of regular summer campers until 6pm. All children must be picked up by 6pm - No Exceptions.
  • Child 1 Information

    *The camp is offered for girls going into 3rd-8th grade in FALL 2015.*
  • mm/dd/yyyy
  • Please identify.
  • Child 2 Information

    *The camp is offered for girls going into 3rd-8th grade in FALL 2015.*
  • mm/dd/yyyy
  • Please identify.
  • Child 3 Information

    *The camp is offered for girls going into 3rd-8th grade in FALL 2015.*
  • mm/dd/yyyy
  • Please identify.
  • All children must reside at the same residence. Please fill out a separate form for any child residing at a difference residence.
  • Parent Information

  • Pick Up Limitations

    *Mother, Father, and Emergency Contact listed are assumed to be allowed pickup unless otherwise notified. You may fill in as many or few contacts as you need here. Anyone picking up your child must be at least 16 and have and ID.*
  • Emergency Contact

  • Demographics

    The following is optional and ONLY used to assist us in obtaining funding and various grants. THIS INFORMATION WILL BE HELD CONFIDENTIAL.
  • Please remember that this inforamtion is held confidential and is merely used for reporting purposes and securing additional grants.
  • Medical Information

    If any information does not apply to your child, please put "N/A"
  • Girls Place Policies and Practices

    The following section includes information regarding payments, releases and our programming. Please read this information carefully. You will be held responsible for all of the content. Please contact Tara at tara@girlsplace.net with any questions.
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  • Yes or No
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  • Signature

  • I have read and fully understand the contents of this application. I have completed the application to the best of my knowledge and ability. I understand that if any information listed in this application changes, I will notify GIRLS PLACE immediately. The child/children listed above has/have my permission to participate in the activities sponsored by GIRLS PLACE as noted on the program schedules. In the case of an emergency an alternate person will be called if the parent(s) can not be reached by phone. The undersigned, individually and as parent or guardian of the participant, hereby authorize GIRLS PLACE to carry out any measures deemed necessary should an emergency occur, including at the expense of the undersigned, appropriate medical treatment for the participant, and hereby releases the GIRLS PLACE, its employees and agents, from any liability or claims arising out of the participant's engagement in the above described events.
  • Type full name here