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, 2009: _________

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) $155
Ages 10 - 14 (Basketball Camp) $190

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, 2009 unless a medical certificate is provided or Kawartha Basketball camp fills the vacancy. All refunds are subject to a $25.00 administration fee.