2012 Summer Camp Application

Name_________________________ e-mail _____________________________________

Address_______________________ City/St./Zip __________________________________

Phone________________________ School _____________________________ Age_____

Please check which Sessions you will be attending:
at The Steward School (9am - 3pm
$230 if received before April 1
$245 if received after April 1

_____ June 25 – 29
_____ July 16 – 20

_____ July 30 – Aug. 3
_____ Aug. 13 - 16 - Girls MS Camp ($140/$130 before April 1)

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

 

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 ___________________________________
Player Name _______________________ Parent Signature _________________________________