2017 Spring Clinics are Filling Fast Please Register Early

Bounce Out the Stigma 2017 Spring Clinic Registration Form

You will be contacted by us either by phone or email to complete your registration process.

 

SELECT 2017 CAMP SESSION & LOCATION*:
---APRIL 1,2017 for 6 Weeks on Saturday 11:00-12:00pm- HAWTHORNE, NJMARCH 21,2017 for 8 Weeks on Tuesdays 5:00-6:00pm - MAHWAH, NJ

CAMPER INFO:

Parent or Guardian's Name * :

Your Relationship to Camper *:

Campers Name ( first, last name only if different from yours } * :

Campers Nick Name:

Campers Age * on January 1, 2017 :

Campers Grade as of January, 2017 * :

T-Shirt Size * :
---Child-MediumChild - LargeAdult-SmallAdult-MediumAdult-LargeAdult- XLarge

Returning Camper*: YESNO

YOUR CONTACT INFO:

Your Email Address *:

Tel. # We Can Reach You* : (format 201-555-1212)

Home Address* :

City* :

Your State* : ---ConnecticutNew JerseyNew York Zip * :

Please Feel Free to Share Any Additional Information About Your Child, that you feel would be helpful.

Add Me To Your Newsletter: YesNo

*Please Tell Us How You Heard About Us
Child's SchoolFacebookGoogleLocal AgencyLocal FlyerIn the MailMighty Mike Harlem Wizards GameEmailReferredOther Online Search

* REQUIRED

If you do not receive a call or forms in the mail in 2 weeks, Please call us at 855.997.3900.

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