Gary Jones, Zolton Walker, Mike Mackley, & Torrian Jones
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Pennsbury Falcons Basketball Summer Camp 2013 Registration ~ Boys & Girls Entering Grades 3rd - 10th ~ Portion Of Camp Fees Will Benefit The Pennsbury Boys Basketball Team Hosted By Pennsbury Head Coach Bill Coleman & His Staff: Gary Jones, Zolton Walker, Mike Mackley, & Torrian Jones Players Information First Name: Last name: Sex: Date of Birth: Age: (Grade the athlete will enter in the fall) (dd/mm/yyyy) Street Address: Address (cont.): Emergency Phone: Home Phone: E-mail: Select Session(s): Please note: your child is not considered registered until this application and payment have been received at above address. T-shirt Size: Shorts Size: • Total Cost $ 155.00 o All fees include a T-shirt and shorts o Includes a $10.00 non-refundable deposit which goes directly to the Pennsbury School District for administrative fees o Full fee becomes non-refundable once camp begins • Payment due July 1, 2013 Parent or Guardian I certify my child to be in good health and give permission for his\her participation in Falcons Basketball Camp. I authorize emergency and medical treatment which may be needed in the event of an injury. I also understand that primary insurance coverage is my own responsibility through my individual or family plan. I agree to defend, indemnify and hold harmless Falcons Basketball and instructional personnel in the event of injury to my child. Please complete one application per athlete. Print 2 copies. Please keep 1 copy for your records and mail 1 copy of this application with payment to: Pennsbury Parent Basketball Club C/O: Michele Jones 230 Woolston Drive, Morrisville, PA 19067 For more information please e-mail [email protected] Session 1, July 8 - 11, 2013 Session 2, July 15 - 18, 2013 Male Female Grade: City: State: Zip: Signature of Parent or Guardian First Name: Last Name: • EARLY REGISTRATION - $10 discount (Before May 1, 2013) Lunch is provided for an additional fee: Option 1: 1 hot dog, 1 bag of chips & a drink - $12 Option 1: 2 hot dog, 1 bag of chips & a drink - $15 $300 for both weeks
Transcript of Gary Jones, Zolton Walker, Mike Mackley, & Torrian Jones
Pennsbury Falcons Basketball Summer Camp 2013 Registration
~ Boys & Girls Entering Grades 3rd - 10th ~
Portion Of Camp Fees Will Benefit The Pennsbury Boys Basketball Team
Hosted By Pennsbury Head Coach Bill Coleman & His Staff: Gary Jones, Zolton Walker, Mike Mackley, & Torrian Jones
Players Information First Name: Last name: Sex:
Date of Birth: Age: (Grade the athlete will enter in the fall) (dd/mm/yyyy)
Street Address: Address (cont.):
Emergency Phone: Home Phone: E-mail:
Select Session(s): Please note: your child is not considered registered until this application and payment have been received at above address.
T-shirt Size:
Shorts Size:
• Total Cost $ 155.00
o All fees include a T-shirt and shorts
o Includes a $10.00 non-refundable deposit which goes
directly to the Pennsbury School District for
administrative fees
o Full fee becomes non-refundable once camp begins
• Payment due July 1, 2013
Parent or Guardian I certify my child to be in good health and give permission for his\her participation in Falcons Basketball Camp. I authorize emergency and medical treatment which may be needed in the event of an injury. I also understand that primary insurance coverage is my own responsibility through my individual or family plan. I agree to defend, indemnify and hold harmless Falcons Basketball and instructional personnel in the event of injury to my child.
Please complete one application per athlete. Print 2 copies. Please keep 1 copy for your records and mail 1 copy of this application with payment to:
Pennsbury Parent Basketball Club C/O: Michele Jones 230 Woolston Drive, Morrisville, PA 19067
For more information please e-mail [email protected]
Session 1, July 8 - 11, 2013
Session 2, July 15 - 18, 2013
Male
Female
Grade:
City: State: Zip:
Signature of Parent or Guardian
First Name: Last Name:
• EARLY REGISTRATION - $10 discount (Before May 1, 2013)
Lunch is provided for an additional fee:
Option 1: 1 hot dog, 1 bag of chips & a drink - $12
Option 1: 2 hot dog, 1 bag of chips & a drink - $15
$300 for both weeks
