Basketball Registration Form

Participant Name(required)

Family Name(required)



Your active Email (required)

Parent/Guardian Name1:
Parent/Guardian Name2:

Cell number for emergency:

Alternative emergency contact: tel#:

For more info contact Living Hope 705.740.9293 or

IMPORTANT: Be sure to print and fill out the Waiver and Release form.
You MUST bring the completed form to Basketball Camp.

We ask that you do this simple math question to prove this is being submitted by a person :

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All right reserved.
1 Consumers Place, Peterborough, Ontario K9L 0C5
Tel.: (705) 740-9293, Fax: (705) 740-9994, Email:
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