Registration Form

Which week(s) of camp are you registering for?

Camper #1 First Name

Camper #1 Last Name

Camper #1 Gender

Camper #1 School Name

Camper #1 Grade in Fall of 2026

Camper # 1 Tee Shirt Size

Camper #2 First Name

Camper #2 Last Name

Camper #2 Gender

Camper #2 School Name

Camper #2 Grade in Fall of 2026

Camper #2 Tee Shirt Size

Camper #3 First Name

Camper #3 Last Name

Camper #3 Gender

Camper #3 School Name

Camper #3 Grade in Fall of 2026

Camper # 3 Tee Shirt Size

Parent / Guardian Full Name

Parent / Guardian Phone number

Parent / Guardian Email

Emergency Contact Name (other than Parent / Guardian)

Emergency Contact Phone number

Insurance Policy Provider

Insurance Policy Number

Please list any medical conditions or other notes (kids will be grouped together by grade)

How did you hear about us?

Check here if you agree to the terms and conditions stated below. I accept and assume any and all risks associated with my child(ren)’s attendance and participation in the camp and its activities, including the risk that my child(ren) may be exposed to or infected by the novel coronavirus by attending and/or participating in camp, and that such exposure or infection may result in personal injury, illness, permanent disability, or death. I understand that my child(ren) should not attend the camp if he/she/they are not healthy. I knowingly and voluntarily agree to comply with all COVID-19-related safety and risk mitigation practices required by applicable law and Camp Organizers, whether communicated verbally or in writing. I understand that my child(ren) must abide by camp policies and the instructions of the camp staff. I agree that should my child be dismissed from camp no part of my tuition will be refunded. I understand that no reduction in the tuition will be made for late arrival, early departure, vacations, illness, or injury. In the event that I cannot be contacted in an emergency, I hereby grant Pioneers Basketball Camp permission to give immediate treatment and/or take my child to a hospital emergency room. Permission is hereby granted for photographs and/or videos to be taken of my child at camp and Pioneers Basketball Camp has the right to utilize these in our brochures, videos, slide shows, website, and other camp materials. Knowing these facts and in consideration for your accepting my child(ren)’s application, I am responsible for accidents, injuries, and/or medical or dental expenses arising from my child(ren)’s participation in the camp and, accordingly, I covenant not to sue, and waive, release, and discharge, Pioneers Basketball Camp and Facilities Named, Valley Forge Middle School and TE Middle School, and anyone working on their behalf from any and all claims of liability or expenses of any kind or nature whatsoever arising out of or relating to my child(ren)’s participation in the camp. If I cancel my registration for any reason before the start of the camp I will receive a refund of my registration fee less a cancellation / service fee of $100. No refunds will be given for any cancellations on or after the first day of camp. All cancellation requests must be in writing with no exceptions. I have carefully read all of the information in this application form and agree to all conditions.

You will receive a confirmation email within 24-48 hours upon receipt of payment.

Registration Form

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