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. Required. 
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 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:
Invalid Input

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?
Invalid Input

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.


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