SWISH PROGRAM
385 City Line Avenue
Phoenixville, PA 19460
(610) 917-2320 (O)
 (610) 917-2320 (F) 
mark@swishprogram.com

 

 

 

SWISH BASKETBALL PROGRAM
ONLINE REGISTRATION FORM

  Name(s)   Age(s)

Contact Name Contact Number
                                                                       
Email Address

How did you hear about us?    If a friend, who?

Program Type:      Individual Instruction 

                             Pre-school Session 

                             Group Session   

                             2008 Summer Camp   

Please Select :         Beginner          Intermediate          Advanced

T-shirt Size (youth)       S        M        L

I,  give permission to
to participate in the SWISH Basketball Program.  I understand that Mark McDonnell, or any other staff member(s) are not responsible for an accident or injury that may occur while participating in this program.

                                                                       
                                                                                  Parent/Guardian Signature

 Please list any pertinent medical information of which we should have knowledge.

EMERGENCY INFORMATION

Name of Child 

Parent/Guardian 

Date of Birth  

Street Address

City         State          Zip 

Home Phone      Work Phone

Cell Phone

Name of Emergency Contact  Phone 

I give permission for my child to be taken to the hospital for emergency treatment when efforts to contact parent/guardian or emergency are unsuccessful. 

  
                     Parent/Guardian                           


Your registration will be confirmed via email.

     Please mail a $25 non-refundable registration deposit fee to the address below. 
Registration fee will be applied to the total tuition of the program. 

Checks payable to S.W.I.S.H. Program:
Mark McDonnell
385 City Line Avenue
Phoenixville, PA  19460
 

 


Home | About Swish | Summer Camps | Group Sessions | One-on-One | Pre-School Sessions 
Fundraisers | Birthday Parties | Register Online | Mail-in Registration | Contact Us

Confidence•Agility•Sportsmanship•Hardwork
Swish Basketball Program
www.swishprogram.com

                                                                                                                                                                                           Copyright ©2007-08 Swish Program