Multnomah Village Basketball Camp Registration

Parent or Gaurdian Name (First and Last)


Participants Name(s), Age(s)

Mailing Address

City, State, ZIP

Daytime Phone, Evening Phone


Email Address


Questions

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Once this form is submitted and processed you will receive a confirmation letter along with a Medical Release Form via US mail. The Medical Release Form must be completed in its entirety and returned to Riversgate Church either by mail or in person at the clinic. Children without a Medical Release Form will not be allowed to participate in the clinic.