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Armond Gorgorian Basketball Overnight Camp

Home/Armond Gorgorian Basketball Overnight Camp

Armond Gorgorian Basketball Overnight Camp nimda 2022-09-13T09:51:50-07:00

22214 Big Pines Hwy
Valyermo, CA 93563

I hereby authorize my(Required)

Son

Daugther

to participate in Armond Gorgorian basketball overnight camp with Homenetmen Glendale Ararat's Basketball Division from Sept. 23-25, 2022.

Player Name(Required)

First Last

Address(Required)

Street Address City State ZIP Code

T-Shirt Size (adult sizes)(Required)

Small

Medium

Large

Extra Large

2X-Extra Large

Camp Fee(Required)

Price:

Email(Required)

Home Phone

Parent's / Guardian Cell Phone(Required)

Parent's / Guardian Cell Phone

Ararat Team / Division(Required)

Coach's Name(Required)

Player's Date of Birth(Required)

MM slash DD slash YYYY

Age(Required)

Sex(Required)

Height(Required)

Weight(Required)

In an emergency, if unable to reach a parent, contact:

Name(Required)

Relationship(Required)

Phone(Required)

Name

Relationship

Phone

Medical Information

Doctor's Name(Required)

Doctor's Phone #(Required)

Medical Insurance Carrier(Required)

Group #(Required)

ID(Required)

Upload a Copy of the Insurance Card(Required)

Max. file size: 128 MB.

Allergic to Medication?(Required)

Yes

No

Allergic to Anything Else?(Required)

Yes

No

If yes please name the medications:

If yes please describe:

Taking any medication?(Required)

Yes

No

Any chronic illness?(Required)

Yes

No

If yes please name them all:

If yes, please name the illness:

Check the items that apply to your child

Asthma

Diabetes

Heart problem

Sleep walking

Seizure

Covid-19 Vaccinated

Consent(Required)

I Consent

In the event of a minor illness, I authorize you to give my child common remedies.

Parent's Name(Required)

Signature(Required)

Billing

Billing Address(Required)

Street Address City State ZIP Code

Credit Card(Required)

American Express

Discover

MasterCard

Visa

Supported Credit Cards: American Express, Discover, MasterCard, Visa

Card Number

Expiration Date Month Year

Security Code Cardholder Name

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