REGISTRATION FORM

 

SESSION: 7-8PM  GRADE 3-6 FEE  $75_________     7:45-9:00PM   GRADE  8-12  FEE $90  ____________   

NAME:________________________________________________ Age: _________ Grade  in Fall:_____________

 

PARENT’S NAME AND                                                                                                                                                                            PHONE:_________________________________________________________________________________________

 

EMAIL:_________________________________________________

Previous basketball experience:

 

I UNDERSTAND THAT BASKETBALL IS A PHYSICAL SPORT AND WILL NOT HOLD MONTGOMERY COUNTY,BLAKE HIGH SCHOOL OR COACH SCHIPANI LIABLE IN THE EVENT OF INJURY

parents signature_______________________________________________

MAKE CHECKS PAYABLE  and  MAIL REGISTRATION FORMS  to:

TERRI  SCHIPANI  920 Windmill Lane  Silver Spring, MD 20905 

240-855-9935

Email Cloverlyhoops@aol.com if you would like to pay by credit card through PayPal and we will send you an invoice.

If mailing after June 10 please email us to confirm space availability.

www.cloverlybasketball.com 

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