Place: Centennial High School (4300 Centennial Lane, Ellicott City, MD 21042 ) Date: December 28 – 31, 2015 Time: 9:00 – 3:00
COST: $150
EACH PLAYER RECIEVES PLUS: • Team T Shirt *Experienced Coaches • Achievement Award Before & After Care Available: Before or After care $25 / Both $40 Before Care 8-9am / After Care 3:00 – 5:00 pm For Further Information contact: Coach McDuffie :
[email protected] or 443-474-4211 HCYP website Name: ________________________________________________________________________________________________________________________ Home Address:_______________________________________________________________________________________________________________ Email:________________________________________________________ _________Phone_________________________________________________ Before Care Y___ N ___ After Care Y ___ N ___ Both Y___ N ___ * Nut Allergy Y___ N ___
School Name:_________________________________________________________________________Age ________Shirt Size_________________ Parent/ Guardian Name:_____________________________________________________________________________________________________________________ Will camper be taking medication during camp? Yes_______ No____ if yes please explain: I hereby register the above camper/campers as a participant in the basketball program. I certify that I am the parent/ legal guardian of the said camper/campers and hold harmless the HCYP,Inc., from any and all liability for any injury, illness or condition that may arise as a result of participation in this program. I also certify that the above camper/campers birth date / age is accurate as indicated. ___________________________________________________________________________________________________ Date:________________________________________ Signature of Parent/Guardian
Mail application: HCYP – Winter Break Camp 2015 Checks Payable to: HCYP Basketball P.O.Box 471, Ellicott City, MD 21041 NO REFUNDS