Vincent Robinson Basketball Academy
The Academy that offers the best individual
 and team instruction in the state of
New Jersey.
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On-line Application

This is the Online Registration form for the Vincent Robinson Basketball Academy Camp of your choice. Please complete a SEPARATE Registration FORM for EACH Participating YOUTH. Please be sure to select which camp you are registering for and to fill in all required information prior to clicking the SUBMIT button. After you complete the form, then click submit, the form will be sent to VRBA Registration for processing (processing normally takes less 24 hrs. --- For faster service please call). As a reminder your registraion form is not to be considered approved until we receive your deposit or payment in full. You will receive confirmation of your approved registration form by email or phone call. Any questions please call 973.204.5413.

VRBA Camp:
Weeks Attending: Wk 1 Wk 2 Wk 3 Wk 4 Wk 5
Site:      West Side High School in Newark, NJ 07103
Participant's First Name
Participant's Last Name:
Age: Date of Birth: M: D: Y:
Gender: Shirt Size:


Address:
Address (cont):
City:
Zip Code: (5 digits)
State:


Guardian's First Name:
Guardian's Last Name:
Home Phone:
Cell Phone:
Work Phone:
Email:


Heatlh Insurance Company:
Policy / ID Number:
Allergies:


Comments:


Waiver:
** I, the undersigned, submit that my child is physically fit to participate in strenuous athletic activity, and waive Vincent Robinson Basketball Academy (V.R.B.A) of any and all responsibility for injury or illness. I hereby authorize the Director of V.R.B.A to act for me according to their best judgment in an emergency requiring medical attention.



Signature Check Box
Typed Signature: Date:


Signature Statement:
 Parent or legal guardian by checking the box on the left, typing your full name and selecting the current date, constitutes as your signature of agreeance giving full consent to the VRBA to process your request to register..

Vincent Robinson Basketball Academy