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Paye's Place Summer Skills Basketball Clinic Registration Form

July 5th, 6th, 7th, 8th, 9th, 2010

Afternoon Session II (1pm - 4pm)
Cost: $175
Ages: 6 to 15

*drop in rates, must be paid at the door (by check or cash) $50 per session/per day

*Download Payes Place Waiver - Release Form - Fill it out and bring in to Office before clinic starts.
Information about you
DOB
CamperName
ParentName
Address
City
St
Zip

How do we Communicate with you?
Home Phone:
Email:
CellPhone:

Pay By:    Check    Credit Card    *Payments

Credit Card Information
*Fill this section out below if you clicked to pay by credit card, otherwise just click I accept.
Credit Card Type
Credit Card Number
Expires
Card Security Code
Name
Street
City
State
Zip
 




I understand that I have signed up for Paye's Place Summer Skills Basketball Clinic. I am committed to attending the clinic. No Refund Policy

Checks are payable to Paye's Place

Thank You,

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