2025 Application Submission – Ron Palmer & Erroll Parker Summer Sports & Academic Camp

Name *

First

Last

Check One: *

Male
Female

Returning Camper?

Street Address, City, Zip *

Parent/Guardian Name (Mother – Occupation) (required field) *

Parent/Guardian Name (Father – Occupation) (required field) *

Parent Email Address (required field) *

Phone for Parent/Guardian (required field) *

Phone for Student (required field) *

Birthdate (MM/DD/YYYY) (required field) *

Medical Insurance Carrier

Doctor Name & Phone Number

Emergency Contact Name, Phone Number, Relationship to Camper (required field) *

School Name & School District (required field) *

Grade Level (required field) *

(required field) T-Shirt Size (All sizes are ADULT sizes, please specify: XS, S, M, L, XL, XXL) *

I certify that the above statements are accurate and true to the best of my knowledge. In addition, I will follow the rules and regulations of the Ron Palmer Summer Basketball Camp/Hoop Smart at all times. If I am asked to leave the camp for behavior problems, I understand that monies are not refundable. I agree to be filmed and photographed and to use digital technology to participate in this camp. I understand that the Ron Palmer Summer Basketball Camp will strive to keep all personal information confidential. *

Parent or Legal Guardian’s Signature & Date (required field)

Please note how you heard about camp if not answered above.

Comments/Questions/Concerns (Responses generally within 24 hours. Please check your spam mailbox.)

IMPORTANT: All camp fees must be paid to insure your student's spot in the camp. Payment deadline is July 15, 2025.

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