SUMMER CAMP
SUMMER CAMP Summer Camp
REGISTRATION FORM One camper per registration form Camp Hours 9 a.m. – 4 p.m. Extended Care Hours: 7:40 AM drop off & 6:00 PM pick up NAME:_____________________________________________________________
DOB: ______________________
q Week 1:June 13-17 q Week 2: July 18-22 $200 (w/ extended care $10 per day) ADDRESS: ________________________________________________________________________________________ CITY: _____________________________________________ STATE: _____________ ZIP: ______________________ SCHOOL: ____________________________________________________ GRADE: ____________ EMAIL: _______________________________________________________________________
MOTHER’S NAME: ___________________________________________________ PHONE: _____________________ FATHER’S NAME: ____________________________________________________ PHONE: _____________________ In case of an emergency, notify the following person if the parents cannot be contacted. NAME:___________________________________________________ RELATIONSHIP: q Mother
q Father
q Guardian
Ph.: _____________________________________________________ I _______________________________ (Please Print Name) authorize my son or daughter to participate in the Back2Basix basketball. I understand that the registration fees DO NOT cover any experience related to AAU Basketball tournaments, state tournaments or any travel expenses for lodging and meals. My q son or q daughter has no medical problems that prohibit him/her from participating in Back2Basix Basketball Camp; therefore I release Back2Basix from any liabilities. I _______________________________(Please Print Name) understand my son or daughter will be held accountable to the rules, regulations and the code of conduct required by Back2Basix. Any violations of these rules may result in suspension from Back2Basix Summer Basketball Camp without refund.
BACK2BASIX SUMMER BASKETBALL CAMP • 704.999.3781 • www.ba2ba.org
SUMMER CAMP
Summer Camp! Registration Is Now Open! Don’t Wait! Space Is Limited!
• Who:
Student Athletes Ages 5-14
• When: Summer Camp: June 13-17, July 18-22 • Where: Midwood Park Wilhemina Avenue Charlotte, NC 28205 • Time: Monday - Friday 9:00 am - 4:00 am • Early drop off 7:45 am & Late pickup 4 pm 6 pm for an additional $10.00 per day) To register Download and complete the registration form then mail the payment and form to: Back2Basix • P.O. Box 853 Huntersville, NC 28078 Registration Fee: Fees $200.00 (with extended care $10.00 per day)
For more information please contact: Coach Thomas Turner 704-999-3781 www.ba2ba.org • [email protected]
REGISTRATION FORM One camper per registration form Camp Hours 9 a.m. – 4 p.m. Extended Care Hours: 7:40 AM drop off & 6:00 PM pick up NAME:_____________________________________________________________
DOB: ______________________
q Week 1:June 13-17 q Week 2: July 18-22 $200 (w/ extended care $10 per day) ADDRESS: ________________________________________________________________________________________ CITY: _____________________________________________ STATE: _____________ ZIP: ______________________ SCHOOL: ____________________________________________________ GRADE: ____________ EMAIL: _______________________________________________________________________
MOTHER’S NAME: ___________________________________________________ PHONE: _____________________ FATHER’S NAME: ____________________________________________________ PHONE: _____________________ In case of an emergency, notify the following person if the parents cannot be contacted. NAME:___________________________________________________ RELATIONSHIP: q Mother
q Father
q Guardian
Ph.: _____________________________________________________ I _______________________________ (Please Print Name) authorize my son or daughter to participate in the Back2Basix basketball. I understand that the registration fees DO NOT cover any experience related to AAU Basketball tournaments, state tournaments or any travel expenses for lodging and meals. My q son or q daughter has no medical problems that prohibit him/her from participating in Back2Basix Basketball Camp; therefore I release Back2Basix from any liabilities. I _______________________________(Please Print Name) understand my son or daughter will be held accountable to the rules, regulations and the code of conduct required by Back2Basix. Any violations of these rules may result in suspension from Back2Basix Summer Basketball Camp without refund.
BACK2BASIX SUMMER BASKETBALL CAMP • 704.999.3781 • www.ba2ba.org
SUMMER CAMP
Summer Camp! Registration Is Now Open! Don’t Wait! Space Is Limited!
• Who:
Student Athletes Ages 5-14
• When: Summer Camp: June 13-17, July 18-22 • Where: Midwood Park Wilhemina Avenue Charlotte, NC 28205 • Time: Monday - Friday 9:00 am - 4:00 am • Early drop off 7:45 am & Late pickup 4 pm 6 pm for an additional $10.00 per day) To register Download and complete the registration form then mail the payment and form to: Back2Basix • P.O. Box 853 Huntersville, NC 28078 Registration Fee: Fees $200.00 (with extended care $10.00 per day)
For more information please contact: Coach Thomas Turner 704-999-3781 www.ba2ba.org • [email protected]
