Professional Documents
Culture Documents
FALL
2015
BASKETBALL
CLINIC
CLINIC INFORMATION
CLINIC SPECIFICS
Fall 2015
Cash
Check
Credit Card
Name ________________________________________________________________________
LAST
FIRST
Address ______________________________________________________________________
1.
2.
3.
Town __________________________________________________________Zip____________
Age_______________ Grade __________ Home Phone ___________________________
Business/Call Phone ____________________ Parent Name _________________________
4.
5.
Email _______________________________________________
FEE ________________
Are there any special health conditions we should be aware of? _______________________
Credit Card Information (VISA or MASTERCARD) ____________________________________
CVV: _______________ Expiration Date ________________________________