Kawartha Basketball Camp Registration Form

Kawartha Basketball Camp & Kawartha Soccer/Basketball Camp
Registration Form

Name:

__________________________________________

Address:

__________________________________________

City:

__________________________________________

Postal Code:

__________________________________________

Date of Birth:

_____	_____	_____
Day	Month	Year

Age as of July 1, 2008: _________

Emergency Contact Name: _____________________________

Emergency Phone #1: _________________________________

Emergency Phone #2: _________________________________

Health Card Number: __________________________________

Height:

______	______
Feet	Inches

School: ____________________________________________

Coach's Name: ______________________________________

T-Shirt Size:

Med

Lrg

XXL

(Adult Sizes)

(Please Circle One)

Kawartha Basketball Camp Cost:

Ages 4 - 9 (Soccer/Basketball Camp) $135
Ages 10 - 11 (Basketball Camp) $170
Ages 12- 14 (Basketball Camp + Kayak/Canoe outing) $190
*Kayak/Canoe outing included at www.pedalnpaddle.ca

Please print this form, fill in the necessary information and send, along with your "Parental Consent Form" and cheque made payable to "Kawartha Basketball Camp" to:

Kawartha Basketball Camp
P.O. Box 2386
Peterborough, Ontario
K9J 7Y8

Printable Parental Consent Form
(Must Accompany Registration Form)

Cancellation Policy: I understand that there are no refunds for cancellations made after June 5th, 2008 unless a medical certificate is provided or Kawartha Basketball camp fills the vacancy. All refunds are subject to a $25.00 administration fee.