Click Here to Print a Copy of this form to fill out 2009 Boys Summer
Varsity / JV
Basketball Clinic
Instruction with Coach Norris
and the Skaneateles Boys Basketball Staff
Fee: $50
Mondays and Tuesdays from 12:30 – 2
From July 6th to August 20th
*This clinic is replacing Coach Norris’ Basketball Camp*
Please send checks to:
Skaneateles Boys Basketball Attn: Jim Ryan
49 East Elizabeth Street
Skaneateles Boys Basketball
Summer Clinic Registration
2009
Name: ___________________________ Date of Birth: __________
Grade Player is Going Into: ________ Home Phone Number: ________________
Cell Phone Number: ___________________ Email: ________________________
Name of Parent(s): _________________________________________________
Address: __________________________________________________________
_________________________________________________________________
Health Conditions:
Please describe any health conditions we should be aware of: _________________________________________________________________
Emergency:
In case of an emergency, when parent(s) cannot be contacted, please contact:
Name _____________________________ Phone _________________________
Address: ___________________________ Relationship: ___________________
Authorization:
I give my permission for __________________________ to participate in the Skaneateles Boys Basketball Summer Clinic. I hereby authorize the coaches or team manager / trainer to provide emergency treatment to my child in the event that I cannot be contacted.
_____________________________________ ________________
(Signature of Parent / Guardian) (Date)
Insurance Carrier _____________________ ID Number _________________
Group Number _______________
Please Send This Form and Payment to:
Make Checks Payable to: Skaneateles Boys Basketball
Any Questions please contact Jim Ryan at 289-6676
