Easley FCA Community Basketball Camp
July 17-20, 2017 at the Larry Bagwell Gym at Red Owens Complex in Easley. Sign up below!!

Time: 8:00AM - 12:30 PM
The gym will be open at 7:45 AM

The camp is FREE! for children who have completed 2nd - 7th Grade.

Breakfast is available beginning at 7:40am. Lunch is provided.

Camper Information

First Name:(*)
Learner's Name required.

Last Name:(*)
Learner's Last Name is required.

Birthdate:(*)
/ / Required.

School Grade Completed This Year(2016-2017):(*)
Grade is required.

Name of School:(*)
Required.

Gender:(*)
Gender is required.

Tshirt Size:(Requested T-shirt size is not guaranteed)(*)
Required.

Parent/Guardian Information

Parent/Guardian Names:(*)
Parent/Guardian is required

Address:(*)
Address is required.

City:(*)
City is required.

State:(*)
State Required

Zip Code:(*)
Zip code is required.

Home Phone:(*)
Home phone is required. If you do not have a home phone, enter a cell or work phone. (xxx-xxxx)

Work Phone: (*)
Work phone is required. If you do not have a work phone, enter a cell or home phone. (xxx-xxxx)

Cell Phone:(*)
Required.(xxx-xxxx) If you don't have a cell phone, write none.

Preferred Email:
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Emergency Contact Information

Emergency Contacts are in case parents/guardians cannot be reached

Primary Emergency Contact Name:(*)
Emergency contact is required.

Primary Emergency Contact Phone:(*)
Emergency contact phone is required. (xxx-xxxx)

Primary Emergency Contact's Relationship to Camper:(*)
Required.

Secondary Emergency Contact Name:(*)
Emergency contact is required.

Secondary Emergency Contact Phone:(*)
Emergency contact phone is required. (xxx-xxxx)

Secondary Emergency Contact's Relationship to Camper:(*)
Required.

Additional Information

Allergies/Medical Conditions: (If none, write none)(*)
Allergies, Medical, & Special Needs required. If none, write none.

Medications Needed During Camp Hours: **Must be labeled with camper name and dosing instructions (If none, write none)(*)
Required. If none, write none.

Do you attend church?(*)
Required.

If so, where do you attend church?

Is this the 1st year your chlid has attended this camp?(*)

Required.

If no, how many years has your child attended?
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After clicking submit, follow instructions on the next page regarding a form to print, sign, and bring with you on the 1st day of camp.