RISING STARS REGISTRATION FORM AND EASY TRANSITION TO SHOPPING CART/PAYMENT FOR FULL ENROLLMENT

After completing registration form below please click "submit form" at the bottom of this page to be automatically transfered to our shopping cart. REGISTRATION IS NOT COMPLETE until all information is filled out in the shopping cart (please select camp location and days your child is attending) and continue processing the order. Your child will then be fully registered and will receive an email confirmation as well as a letter by mail. Thank you!

You must compete this form, and pay for the camp in our shopping cart to be registered for a Rising Stars Basketball Camp.

Camper Name*		Grade*
Emergency Phone*	(XXX) XXX-XXXX If for some reason a player's parent or guardian is not present, we must be able to contact you in case of injury. We require a cell phone # or pager # where you may be reached at all times your child is unaccompanied. This number will be kept confidential and only used in an emergency.	Email Address*
Address*		Address Line 2
City*		Zip Code*
Insurance Company *		Policy Number *
Select a Location:		Select a Date:
Waiver: I hereby authorize the directors of the Rising Stars Clinics, Inc. to act for me according to their best judgment in any emergency requiring medical attention. I hereby waive and release Rising Stars Basketball Clinic, Inc. from all liability and agree to accept all medical expense incurred. I know of no mental or physical problem which would affect my child’s ability to safely participate in the clinic.. By initialing in the box below I confirm that I have read and understand the above waiver *
When you click on the "Submit Form" button you will be re-directed to the Shopping Cart where you need to pay for your child's registration - Thank You!!
Please do not hit the submit button more than once

Sportsarama

CBA

4209 Gateswalk Way - Smyrna, GA 30080 - Phone: 864-325-9552