BOUNCE OUT THE STIGMA 2019 Saturday Afternoon Basketball Clinic
in conjunction with our Sponsor the Julia Anne Kirsch Foundation

Special Needs Basketball Clinic 5 Weeks on Saturday Afternoons, Starts January 5, 2019** |  Glen Rock, New Jersey

Basketball Camp Registration Bounce Out the Stigma

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Cost of this Clinic is $50.00* – Which Covers 5 Weeks – Each Child Gets a Basketball & Certificate of Accomplishment
* Clinic Schedule: Saturdays 1:30-3:00  ** Jan 5, 12, 19, 26 – Feb 9 (no clinic on Feb.2)

  *Payment is due in full on first day of Camp

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

2019 Glen Rock Clinic REGISTRATION FORM


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Registration Form 2019 Basketball Clinic Glen Rock NJ
All Fields Are Required.

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, 2019 :

Campers Grade as of Sept, 2018 * :

Returning Camper*: YESNO

YOUR CONTACT INFO:

Your Email Address *:

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

Home Address* :

City* :

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

To Avoid Spam, Please Insert the Code You See
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In Conjunction With and Our Underwriting SponsorJulia Anne Kirsch Foundation

 

Learn More About Julia Anne Kirsch Foundation 

 


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