3 0N 3 APPLICATION

Name____________________________________ e-mail_______________________________________________

Address_______________________________________________________________________________________

Phone_____________________________ School _____________________________________________ Age_____

Sept. 26, Oct, 10, 17, 24, 31, Nov.7 ($75)
6:15 - 9 pm at the Steward School
Check the league you will play in:   ___ HS Boys      ___ HS Girls      ___ MS Boys      ___ MS Girls     

Make checks payable for $75 to Bob Foley
Mail all applications to: 11308 Deephaven Ct ; Richmond , Va. 23233

*************Assumption of Liability******************

I understand that this program carries the possibility of physical injury and may involve physical activity that may be strenuous and that there are risks inherent in this
recreational activity. I further understand that Next Level Basketball and its officers and agents are not liable for any injuries that may result from the negligence of
persons conducting this program. It is recommended that participants secure adequate medical insurance to cover any injuries that may arise from participation in
Next Level Basketball's programs.
Pease list any allergies, special conditions, or special needs _________________________________________________________

Parent Signature______________________________________ Work /Cell phone _________________________________