Name_______________________________ e-mail ____________________________________

Address_______________________________________________________________________

Cell Phone__________________________ School ____________________________ Age_____

Please check which Sessions you will be attending:

SUMMER CAMPS
at the StewardSchool 11600 Gayton Rd. , Richmond , Va. 23233
____ July 12 - 16   (9am - 3pm)   ($235)

____ July 26 - 30   (9am - 3pm)   ($235)

____ August 9 - 13   (9am - 3pm)   ($235)

at the Shady Grove YMCA
____ August 2 - 6   (9am - 3pm)   ($245)
BOYS MIDDLE SCHOOL CAMP (at the Steward School)
Aug. 9 - 12 (7 - 9pm) ____ $125


GIRLS MIDDLE SCHOOL CAMP (at the Steward School)
Aug. 24 - 27 (7 - 9pm) ____ $125

There will be an additional $10 fee for registrations received after July 4

Make checks payable 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 ____________________________