Application Form For Summer
Basketball Camp 2010

Choose which session (s)  you will be attending below:


SESSION 1: June 14-18
SESSION 2: June 21-25  |  SESSION 3: June 28-July 2
SESSION 4: July 12-16  |  SESSION 5: July 19-23
SESSION 6: July 26-30  |  SESSION 7: August 2-6
SESSION 8: August 9-13

 
SESSION (s)  ATTENDING*:


USE FIELD BELOW TO CHOOSE SINGLE SESSIONS:
Single Session :

USE FIELDS BELOW TO CHOOSE MULTIPLE SESSIONS:
(up to 8 sessions, choose 1 session per field)

Session:     Session:

Session:      Session:

Session:    Session:

Session:    Session:

Method Of Payment

Name

Email

Height

Weight

Age

Grade

School

Home Phone

Emergency Phone

Address

City

State

Zip Code

Medical Insurance Co.

Policy No.

Parent/Gaurdian Name

 (Authorizes Enrollment & Treatment in Case of Emergency)

Date

             

Please fill out every field in this form & submit

PLEASE CLICK SUBMIT BUTTON ONCE!!! - If you click it
more than once it will duplicate your application - THANK YOU!

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Lightning Basketball Camp   
Jason Looky, Director
(954) 629-0621
E-mail: jlooky@aol.com