SWISH BASKETBALL PROGRAM
ONLINE REGISTRATION FORM

  Name(s)   Age(s)

Contact Name Contact Number
                                                                       
Email Address

How did you hear about us?  Select from the list Brochure Mailer Friend TV Radio Website-Internet Other   If a friend, who?

Program Type:      Individual Instruction 

                             Pre-school Session 

                             Group Session    Select Day and Age Group Saturdays age 9 thru 12 10a-11a

                             2008 Summer Camp    Select Day and Age Group July 7 thru 11 Age 8 to 10 July 14 thru 18 Age 11 to 13 Aug 4 thru 8 - Ages 5 to 7

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.