Name_______________________________ e-mail ____________________________________

Address_______________________________________________________________________

Cell Phone__________________________ School ____________________________ Age_____

Please check which Sessions you will be attending:

3 ON 3 LEAGUE March 21, 28, April 11, 18, 25 and May 2 at the Steward School ($75)
_____ Boys and Girls ages 8 - 11 (7 - 8pm)
_____ Boys and Girls ages 12 - 15 (8 - 9pm)

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)

There is a $15 discount on all Day Camps for applicaions received by April 1

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

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 ____________________________