Camp Application
| Location: |
Niagara High School 700 JeffersonSt, Niagara WI |
| Time: |
9:00 am-12:00pm |
| Ages: |
6-17 /Grades 1-12 -Boys and girls |
| Please select the camp and payment option. |
| ____Session 1 December 26, 2005 |
_____$35 Full Payment |
_____$15 non-refundable deposit. |
Balance due no later than first day of chosen session. You will receive a letter confirming your spot in the camp
upon receipt of payment or deposit.
- THE DEPOSIT IS NON-REFUNDABLE.
- Cash / Checks Accepted Only
- MAIL TO: Anna DeForge Camp 296 Hoover Ave Niagara, WI 54151
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Name PLEASE PRINT CLEARLY Grade  e-mail address
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Street City State Zip
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Home phone Guardian business phone Participant's Social Security#
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Age Date of Birth Height Weight T-Shirt Size(S M L XL) Circle your choice
DISCLAIMER
I hereby authorize the staff of the "Anna Deforge Basketball Camp" to act for me according to their best judgment in any emergency requiring medical attention and I hereby waive and release the Camp from any and all liability for any injuries or illnesses incurred while at Camp. I have no knowledge of any physical impairment that would affect the camper's participation, named to the above, in the camp program as outlined in the information on this web site. I also understand the Camp retains the right to use, for publicity and advertising purposes, photographs of campers taken at camp.
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Parent or Guardian's Signature |