Checks: Checks payable to REGENTS OF U.C.

By Mail: Mail the completed enrollment form with payment to:

Cal Golden Bear Basketball Camp For Boys Men's Basketball Office 209 Memorial Stadium Berkeley, CA 94720

Call our camp hotline at (510) 643-9864.

UNIVERSITY OF CALIFORNIA RELEASE AGREEMENT

I understand that there are risks and dangers inherent in participating and/or receiving instruction in Basketball Camp, I also understand that in order to be allowed to participate and/or receive instruction in Basketball Camp I must give up my rights to hold The Regents of the University of California liable for any injury or damage which I may suffer while participating and/or receiving instruction in Basketball Camp.

Knowing this, and in consideration of being permitted to participate and/or receive instruction in Basketball Camp, I hereby voluntarily release the Regents of the University of California from any and all liability resulting from or arising out of my participation and/or receipt of instruction in Basketball Camp.

I understand and agree that I am releasing not only the entities set forth in the paragraph above, but also the officers, agents, and employees of those entities.

I understand and agree that this Release will have the effect of releasing, discharging, waiving and forever relinquishing any and all actions or causes of action that I may have or have had, whether past, present or future, whether known or unknown, and whether anticipated or unanticipated by me, arising out of my participation and/or receipt of instruction in Basketball Camp. This Release constitutes a complete release, discharge and waiver of any and all actions or causes of action against the Regents of the University of California, and its officers, agents or employees.

I understand and agree that this Release applies to personal injury, property damage, or wrongful death which I may suffer, even if caused by the acts or omissions of others.

I understand and agree that by signing this Release, I am assuming full responsibility for any and all risk of death or personal injury or property damage suffered by me while participating and/or receiving instruction in Basketball Camp.

I understand and agree that this Release will be binding on me, my spouse, my heirs, my personal representatives, my assigns, my children and any guardian ad litern for said children.

I understand and agree that by signing this Release, I am agreeing to release indemnity and hold The Regents of the University of California and their officers, agents and employees harmless from any and all liability or costs, including attorneys fees, associated with or arising from my participation and/or receipt of instruction in Basketball Camp.

I understand and agree that by signing this Release on behalf of my minor child, that I will be giving up the same rights for said minor as I would be giving up if I signed this document on my own behalf.

I acknowledge that I have read this Release Agreement and that I understand the words and language in it. I have been advised of the potential dangers incidental to participating and/or receiving instruction in Basketball Camp.

I understand, agree and acknowledge that some activities may be of a hazardous nature and/or include physical and/or strenuous activity. Understanding this I state to the best of my knowledge, my son/daughter listed on this application has no medical, physical, mental, or emotional health conditions which would hinder his/her active participation in the youth sports programs.

I understand that I am required to have accidental medical coverage for the child listed on this application, and I verify that the information provided on my insurance policy is accurate and true.

In the case of an injury, I authorize the staff of the University of California to render first aid and/or to obtain whatever medical treatment he/she deems necessary for the welfare of my child listed on this application. I further understand and agree that I will be financially responsible for all charges and fees incurred in the rendering of said treatment, regardless of whether my medical insurance would cover such charges and fees.

I understand that at the discretion of the camp supervisor and staff my child may be dismissed from the camp/classes without refund for inappropriate behavior.

 NONDISCRIMINATION STATEMENT

In accordance with applicable Federal laws the University of California does not discriminate in any of its policies, procedures, or practices on the basis of race, color, national origin, sex, sexual orientation, age or handicap.

NCAA RESTRICTION

CAL BASKETBALL CAMP FOR BOYS

ENROLLMENT FORM

One Form Per Child - Fill Out Both Sides - Please Print Clearly Incomplete or Illegible Forms Will Be Returned Unprocessed

Child's Name________________________________________________________________

Last____________________________________ First Initial________________________

Street______________________________________________________

City_____________________ State__________________ Zip Code___________

Emergency______________________ Day Phone__________________________

Contact___________________________________________

(Local):___________________________________________

Child's Doctor:_______________________________________________

Last

Medical Insurance________________________________________________

Information:________________________________

Company_________________ Policy Number___________________ Expiration Date_____

Payment: Make checks payable to "Regents of UC".

Credit Card:________________________________________________

Name (Please Print)

Last____________________________ First_____________________

Day Phone__________________________

First

Eve Phone__________________________

Last First

( I

Eve Phone

( I

First

First

Phone

Phone

Card Number

Parent/Guardian Release:

I am the parent or legal guardian of the minor (name) I have read, understood, and agree to the terms and conditions on both sides of this application and I am signing this Release on behalf of said minor.

Print Name of Parent X

Expiration Date

Complete this form and mail to: Golden Bear Basketball Camp For Boys Men's Basketball Office 209 Memorial Stadium Berkeley, CA 94720

Address

State

Birthdate - /

Does participant have any physical limitations or disabilities? -YES -NO

If yes, describe:

PARENT/GUARDIAN, EMERGENCY CONTACT,

AND DOCTOR SECTIONS MUST BE COMPLETED

Parent/ Guardian 1:

Parent/ Guardian 2 or other Contact:

( I

Last

Signature of Parent X__________________________________________________________

Check (./) desired session(s) below:

__Session #1 June 21-25

__Session #2 August 2-6