Online Camper Registration
Day Camp
Location:
Bishop O' Connell High School
6600 Little Falls Road
Arlington, VA 22213
Participant's Information
First Name
Last Name
Parents Email: Primary address to send information
Address
City
State/Province
Zip/Postal Code
School name
Date of birth
Male/Female
Select One
Male
Female
Group name
(must match, text and case sensitive)
Users Information (to log into account)
Email
Password
Repeat Password
Sessions and Extended Care.
July 27 - 31
Optional Before / After Care (non Refundable)
None
Morning: $30.00 per week
Afternoon: $35.00 per week
AM/PM Combo: $45.00 per week
August 3 - 7
Optional Before / After Care (non Refundable)
None
Morning: $30.00 per week
Afternoon: $35.00 per week
AM/PM Combo: $45.00 per week
Medical Information
Parent/Legal Guardian Name
Phone
Emergency Contact Name
Emergency Contact Phone
Emergency Contact relationship to camper
Insurance Company
Insurance Policy Holder
Policy Number
Insurance Group Number
Physician name
Physician Phone
Medical Hitsory (check all that apply)
Allergy
Seizure
Food or other
Asthma
Diabetes
Other chronic health conditions
Prescription medicine (see medication section below)
Other Medications
Explain if you checked any boxes above
Medication (reason, dosage, timing, camper is required to have one dosage before camp)
The above-listed medication(s) may be given to the above-named camper
Yes
I give permission for my child to take more then one dose of over-counter medications(s) (pain reliever, antacid, cough meds, etc.). The camp stocks these medications so there is no need to send them to camp.
Yes
Consent to release
I hereby give permission to Coach Wootten’s Basketball, LLC., its officers, employees, agents, trainers, and staff members to take whatever action is necessary for the health and welfare of my child including consenting on my behalf to any and all medical treatment, procedures, operations and/or hospitalizations and I further agree to hold them harmless and indemnify them for all medical bills incurred for the treatment of my child. I understand that basketball is a very physical sport and which can result in serious injury. I hold Coach Wootten’s Basketball, LLC., its officers employees, agents, trainers and staff members harmless and hereby release them from liability for any injury to my child while attending the camp.
Yes
I hearby give permission for my child to be transported to other local gymnasiums and O'Connell certified bus driver.
Yes
Accept privacy and condition of use policies.
Yes
Promo Code
How did you hear about us?
Select One
Social Media
Email
Social Media
Word of Mouth
Online Search
Past Camper
Brochure
Attended Coach Wootten Event
Other