Campers Name:     Street:  
City: State:     Zip: Phone:
cell:      Shirt Size: Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult Extra Large Adult XXL   Age:   Grade:    Fall 2009 grades
Birth Date:     E-Mail   School:

K thru 4th Grade  Junior Basketball Camps $75 each Session  pre registered & Paid Boys & Girls

K1 Jun 27-30 at BCH Riverfront 9:00 - 12:00
K2 July 11-14 at BCH Riverfront 9:00 - 12:00
K3 July 18-21 at BCH Riverfront 9:00 - 12:00
K4 July 25-28 at BCH Riverfront 9:00 - 12:00
K5 Aug 1-4 at BCH Riverfront 9:00 - 12:00
K6 Aug 8-11 at BCH Riverfront 9:00 - 12:00
K7 Aug 15-18 at BCH Riverfront 9:00 - 12:00

2nd thru 6th Grade  Sports & Fitness Full Day Camp Boys and Girls Cost $135 pre registered & Paid
SF1 July 11-14 at BCH Riverfront 9:00am - 4:00pm
SF2 Aug 8-11 at BCH Riverfront 9:00am - 4:00pm CANCELED

5th thru 9th Grade  Nothing But Shooting  Basketball Camp Boys and Girls Cost $65 pre registered & Paid
  NS1 July 11-14th 1:00 to 4:00 pm at  BCH2 Ice Box
  NS2 Aug 15-18th 1:00 to 4:00 pm at  BCH Riverfront

5th thru 9th Grade  Amber Jacobs  Basketball Camp Boys and Girls Cost $85 pre registered & Paid
  AJ1 June 27-30th 12:45 to 4:15 pm

5th thru 9th Grade Dave Martin Basketball Camp 1 Boys and Girls Cost $85 pre registered & Paid
DM1  July 18-21st 12:45 to 4:15 pm

5th thru 9th Grade Pat Shields Basketball Camp Boys and Girls Cost $75 pre registered & Paid
CANCELED  PS1 JULY 25^TH - July 28^TH 12:45 to 4:15 pm

5th thru 9th Grade Andrew Kettle Basketball Camp Boys and Girls Cost $75 pre registered & Paid
AK1 Aug 1st- Aug 4th 12:45 to 4:15 pm at  BCH2 Ice Box

5th thru 9th Mike Show Basketball Camp Boys and Girls Cost $85 pre registered & Paid
MS1 Aug 8th-11th 8:45-12:15pm at  BCH2 Ice Box

7th thru 12th NE Alliance Volleyball Camp Boys and Girls Cost $80 pre registered & Paid
VB1 June 20-23 Girls 8:45-12:15pm at  BCH
VB2 June 20-23 Boys 12:45 to 4:15pm at  BCH

Total Amount for All Camps registering

Health Insurance Co.      Group #: Policy #:
My child is in excellent physical health and capable of participating in strenuous physical activity, and waive Backcourt Hoops of any and all responsibilities for injury or illness. I hereby authorize the director of Backcourt Hoops to act for me according to their best judgment in any emergency requiring medical attention. I understand that I am solely responsible for the payment of any such medical expenses and must provide Backcourt Hoops with proof of insurance. I also understand that my payments are non-refundable, non-transferable under any circumstances.
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