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Summer

Fall 2015 SPD Basketball Clinic Registration Form


First Name of Student
Last Name of Student
Gender
Male
Female
Student Grade

Parent Information
Parent Name
Parent Email Address
Phone Number
I am the legal guardian/custodial parent
Yes
No
Emergency Number
Address Line 1
Address Line 2
City
State
Zip Code

Select your sessions below, options for all 8 sessions or weekly.
All 8 Sessions
Grades 1-5 from 3:30-4:25 pm
Grades 6-10 from 4:35-5:30 pm
Saturday, October 3
Grades 1-5 from 3:30-4:25 pm
Grades 6-10 from 4:35-5:30 pm
Saturday, October 10
Grades 1-5 from 3:30-4:25 pm
Grades 6-10 from 4:35-5:30 pm
Saturday, October 24
Grades 1-5 from 3:30-4:25 pm
Grades 6-10 from 4:35-5:30 pm
Saturday, October 31
Grades 1-5 from 3:30-4:25 pm
Grades 6-10 from 4:35-5:30 pm
Saturday, November 7
Grades 1-5 from 3:30-4:25 pm
Grades 6-10 from 4:35-5:30 pm
Saturday, November 14
Grades 1-5 from 3:30-4:25 pm
Grades 6-10 from 4:35-5:30 pm
Saturday, November 21
Grades 1-5 from 3:30-4:25 pm
Grades 6-10 from 4:35-5:30 pm
Saturday, December 5
Grades 1-5 from 3:30-4:25 pm
Grades 6-10 from 4:35-5:30 pm
I approve of this Parent/Guardian authorization.
Signature required to process this registration
Yes
No
Electronic Signature

$20 per session or $120 for all eight sessions. Payment should be mailed to:
10615 Brunswick Avenue
Kensington, MD 20895

Checks should be made out to Burke Basketball, please. 
How did you learn about this SPDBasketball Activity?

SPDBasketball reserves the right to cancel any program or service for insufficient enrollment. In such cases, tuition payments would be refunded.

SPDBasketball reserves the right to dismiss, without tuition refund, any student whose conduct is inappropriate or unsafe.

SPDBasketball reserves the right to make substitutions of and/or changes to the activities offered.

SPD Basketball Camp Registration


First Name of Student
Last Name of Student
Gender
Male
Female
Date of Birth
Attending School
Grade entering Sept. 2017
Camp Shirt Size
Youth S
Youth M
Youth L
Adult S
Adult M
Adult L
Adult XL

Select your sessions below.
Select your week(s) below by adding a 1 in the field.
Week 1 CLOSED  @ $269.00
Week 1 CLOSED  @ $373.00
Week 2 CLOSED  @ $186.00
Week 3 July 3 - 7 (July 4th No Camp) Afternoon Only 12:30- 3:30pm Grades 3-10 Coed  @ $155.00
Week 4 July 10 - 14 Afternoon Only 12:30- 3:30pm Grades 3-10 Coed  @ $171.00
Week 5 July 17 – 21 Afternoon Only 12:30- 3:30pm Grades 3-10 Coed  @ $171.00
Week 6 July 24 - 28 Full Day 9:00am - 3:30pm Grades 3 - 10 Co-ed  @ $269.00
Week 7 July 31- Aug. 4 Full Day Full Day 9:00am - 3:30pm Grades 3 - 10 Co-ed  @ $269.00
Week 7 July 31- August 5 Extended Day 8:00am - 5:00pm Grades 3- 10 Co-ed  @ $373.00
Form Total: $0.00

Parent/Guardian Information
Parent/Guardian Name
Address
City
State
Zip Code
Parent/Guardian Email Address
Phone Number
Emergency Number
I am the legal guardian/custodial parent
Yes
No
I approve of this Parent/Guardian authorization.
Signature required to process this registration
Yes
No
Electronic Signature
Name on Card
Billing Address
City
State
Zip Code
Card Number
Card Type
CVV Code
Expiration Month
Expiration Year (last two digits 2016 would be 16)
How did you learn about this SPDBasketball Activity?

SPDBasketball reserves the right to cancel any program or service for insufficient enrollment. In such cases, tuition payments would be refunded.

SPDBasketball reserves the right to dismiss, without tuition refund, any student whose conduct is inappropriate or unsafe.

SPDBasketball reserves the right to make substitutions of and/or changes to the activities offered.

Refunds will not be granted, funds may be used towards a future camp, clinic or training.
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