GUB Camp Registration and Indemnity Form This form is for participants in the June/July school holiday SuperCamps and VJBL Intensive Skills Session. GUB Holiday Camp Registration & Indemnity All GUB Camp participants should complete both the online payment process AND this form to finalise their registration. Name* First Last Gender*MaleFemaleDate of Birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920School* Current level of basketball participation?*Never PlayedPlayed at school/homeAussie Hoops Participant0-1 Year playing community basketball2-4 Years playing community basketball5+ Years playing community basketballVJBL PlayerParent Name* First Last Parent Phone Parent Email Emergency Contact Name* First Last Emergency Contact Phone* Emergency Contact Relationship* Medical NotesPlease provide details of any medical conditions (including learning difficulties or behavioural issues, such as ASD, ADHD, etc) that our staff should be aware of.Other NotesPlease detail the names (first and last) of any friend/s that your child would like to be grouped with on the day. You may also include any further details that may assist us to provide the best experience for your child.Registration/Payment Completed by:If your child was registered (paid) by someone other than the parent/guardian listed on this form, please advise, so we can match the completed indemnity form with the payment. Indemnity*I hereby authorise the staff and volunteers of Geelong United Basketball to act for me according to their best judgement in any emergency requiring medical attention, and I agree to indemnify Geelong United Basketball and its staff and volunteers in respect of anything so done. In addition, I hereby waive and release Geelong United Basketball and its staff and volunteers from any liability for any injury or illness sustained or experienced whilst at the GUB SuperCamps or VJBL Camps. I understand that public liability and professional indemnity insurance is held by Geelong United Basketball, but subject to the terms of the relevant policies. I also understand and agree that Geelong United Basketball has the right to use for publicity and advertising purposes any photographs or video footage of participants taken during the GUB SuperCamps or VJBL Camps. I agree to the terms and conditions.