Register

2019 Registration is CLOSED. Camp has reached capacity.

The cost of camp is $200 if registered before May 1, 2019. Registration after May 1 will be $225. A discount of 10% can be applied for each sibling.

Payment can be made electronically at the bottom of the registration form or by check made out to:
Pioneers Basketball Camp, LLC. 682 Pugh Road Wayne, PA 19087

Please fill out the form below and click submit. Then click on the payment button for the appropriate number of campers you have registered.

Camper's First Name(required)

Camper's Last Name(required)

Gender(required) Male

Female

School Name(required)

Grade Fall 2019(required)

Shirt Size(required)

Camper #2 First Name

Camper #2 Last Name

Camper #2 Gender Male

Female

Camper #2 School Name

Camper #2 Grade Fall 2019

Camper #2 Shirt Size

Camper #3 First Name

Camper #3 Last Name

Camper #3 Gender Male

Female

Camper #3 School Name

Camper #3 Grade Fall 2019

Camper #3 Shirt Size

Parent First Name(required)

Parent Last Name(required)

Full address (City, State, Zip)(required)

Phone Number(required)

Email(required)

Emergency Contact Name & Relation to Child(required)

Emergency Contact Phone(required)

Insurance Policy #(required)

Provider Name(required)

Please list any medical problems or required treatment for all campers registered above(required)

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. I understand that my child(ren) should not attend the camp if he/she/they are not healthy. 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, web site, 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 Facility Named, Conestoga High 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.(required)

How did you hear about us?

Click the “Submit” button above to register your child(ren),
then select the appropriate payment option to finalize the registration process.

Register

2019 Registration is CLOSED. Camp has reached capacity.

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