2017 Winter Clinics are Filling Fast Please Register Early

15 SPOTS LEFT
REGISTRATION IS NOW OPEN – RESERVE YOUR SPOT

Bounce Out the Stigma 2017 Winter Clinic Registration Form


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


 

SELECT 2017 CAMP SESSION & LOCATION*:

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 * :

Returning Camper*: YESNO

YOUR CONTACT INFO:

Your Email Address *:

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

Home Address* :

City* :

Your State* : 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

* REQUIRED

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

To Avoid Spam, Please Insert the Code You See
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