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2006 Camp
Dates (check the box):
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Boy's & Girl's 4th-8th Grade |
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July 20, 21, 22 @ F.C.R.H.S.}
9am
- 2pm |
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Boy's & Girl's 8th-12th Grade |
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July
23, 24, 25 @ F.C.R.H.S.} 9am
- 2pm * |
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*Sunday's Time: 11am - 4pm |
| Player Information
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| Last Name:
______________________ First Name: ____________________ Grade:____ (Fall 2006)
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| Address: ______________________________ City:
___________________ State: ___ Zip: _______
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| Phone Number: (_____) _____ -
________
Email Address: _________________________________
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| Age: ____ Date of Birth:____/____/____ Height: __'___" Weight: _____
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| T-Shirt Size
(Adult Sizes) (Please Circle): XL, L, M, S
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Please list any physical illnesses NextLevel Hoops
should be aware of (allergies, illnesses, disabilities, etc .):
__________________________________________________________________________________
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School Information
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Name:
____________________________________Coach: __________________________________
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Parent/Guardian
Information
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Last Name: ________________________________ First Name:
______________________________ |
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Home Number: (______) ______ - ________ Work Number:
(______) ______ - ________
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Email:_________________________________________ |
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Insurance Information
(Required)
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Insurance
Company: ________________________________
Insurance #: ____________________
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Waiver
(Required)
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I,
the undersigned, authorize enrollment and submit that my
son/daughter is physically fit to participate in strenuous
athletic activity, and waive NextLevel Hoops, its staff,
affiliated entities, their officers, agents and employees from and
against any injury, recurrence of any undisclosed pre-existing
injury of illness prior to the first day of the session, and all
liabilities or causes of action arising out of or in connection
with my child's participation in this camp.
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_________________________________
(Parent/Guardian Signature) |
_______________________________
(Print Name) |
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Date:____/____/________ |
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Applications
postmarked prior to June 1st receive a $10 discount. |
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Applications
postmarked after June 1st but prior to July 1st receive a $5 discount. |
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Send your
application in the same envelope along with two of your
friend's applications, and receive an
additional $5 off each campers fee. |
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Payments are non refundable. |
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All campers must supply insurance information. |
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Campers must
supply their own lunch. |
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Make
checks or money orders payable to: NextLevel Hoops
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Mail
to: NextLevel Hoops, 233 South Main Street, Forest City, PA 18421 |
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You
may make as many additional copies of the enclosed information and
applications as you may require.
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After receiving your application, directions and list of items
needed for camp will be emailed to you.
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