BASKETBALL DAY CAMP REGISTRATION FORM

Name_______________________________________________

Street_______________________________________________

City______________________State_________ Zip Code_________ Phone__________

Grade next fall_____________ School________Height_________Age______

Accident_____________________________________________________________________________

Insurance Company_________________________________________________________________________

Signature of Parent_________________________________________________________________________

A $50.00 non -refundable deposit must accompany this application. Your remaining balance will be paid on opening day during registration. Make checks payable to CANISIUS COLLEGE BASKETBALL CAMP. Final information concerning registration, time, etc. will be mailed upon receipt of deposit.

For additional information call: MIKE MAC DONALD Head Basketball Coach (716) 888 - 2982.

Please mail to: Canisius College Basketball Camp, 2001 Main Street

Koessler Athletic Center, Buffalo, New York 14208