BOUNCE OUT THE STIGMA 2020 Sunday Afternoon Basketball Clinic
in conjunction with our Sponsor the Julia Anne Kirsch Foundation

Special Needs Basketball Clinic 5 Weeks on Sunday Afternoons, Starts January 5, 2020** |  Glen Rock, New Jersey

Basketball Camp Registration Bounce Out the Stigma

Click on Flyer to Enlarge or  Download a PDF File to Print →

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

  *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

2020 Glen Rock Clinic REGISTRATION FORM


Registration Form 2020 Basketball Clinic 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, 2019 :

Campers Grade as of Sept, 2019 * :

Returning Camper*: YESNO


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


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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