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about us? (Please Circle)
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- Radio - Website/Internet - Other
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Beginner
Intermediate Advanced
Program Type:
Individual
Instruction
Pre-school
Session
Group
Instruction Date and Age Group_________________________
2008
Summer Camp Date and Age Group_________________________ T-shirt Size
(youth) S M L
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
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_________________________________________
Street Address
_______________________________________________________ญญญญญญ_________
City ________________________State_______Zip_______
Home Phone ______________________________WorkPhone______________________
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.