BOUNCE OUT THE STIGMA 2018 Saturday Afternoon Basketball Clinic

Special Needs Basketball Clinic 5 Weeks on Saturday Afternoons, Starts January 6, 2018 |  Glen Rock, New Jersey

Basketball Camp Registration Bounce Out the Stigma

Special Needs Basketball NJ, Glen Rock

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Cost of this Clinic is $50.00 – Which Covers 5 Weeks and Each Child Gets a Basketball and Certificate of Accomplishment

 SPACE IS LIMITED – This Clinic Will Fill Up Fast, Please Register Now, Using This Form



Registration Form Jan. 6, 2018 for 5 Weeks on Saturday 1:30-3:00pm- Glen Rock, NJ
All Fields Are Required.


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, 2018 :

Campers Grade as of January, 2018 * :

T-Shirt Size * :

Returning Camper*: YESNO


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


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

In Conjunction With and Our Underwriting SponsorJulia Anne Kirsch Foundation


Learn More About Julia Anne Kirsch Foundation 


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