NextLevel Hoops

2006 Camp Application


2006 Camp Dates (check the box):


Boy's & Girl's 4th-8th Grade July 20, 21, 22 @ F.C.R.H.S.} 9am - 2pm
Boy's & Girl's 8th-12th Grade July 23, 24, 25 @ F.C.R.H.S.} 9am - 2pm *

*Sunday's Time: 11am - 4pm


Player Information  
Last Name: ______________________ First Name: ____________________ Grade:____ (Fall 2006)  
Address: ______________________________ City: ___________________ State: ___ Zip: _______
Phone Number: (_____) _____ - ________ Email Address: _________________________________  
Age: ____  Date of Birth:____/____/____  Height: __'___Weight: _____ 
T-Shirt Size (Adult Sizes) (Please Circle): XL, L, M, S  
Please list any physical illnesses NextLevel Hoops should be aware of (allergies, illnesses, disabilities, etc .):


School Information


Name: ____________________________________Coach: __________________________________


Parent/Guardian Information


Last Name: ________________________________ First Name: ______________________________


Home Number: (______) ______ - ________   Work Number: (______) ______ - ________ 

Insurance Information (Required)
Insurance Company: ________________________________ Insurance #: ____________________  


Waiver (Required)


I, the undersigned, authorize enrollment and submit that my son/daughter is physically fit to participate in strenuous athletic activity, and waive NextLevel Hoops, its staff, affiliated entities, their officers, agents and employees from and against any injury, recurrence of any undisclosed pre-existing injury of illness prior to the first day of the session, and all liabilities or causes of action arising out of or in connection with my child's participation in this camp.


(Parent/Guardian Signature)
(Print Name)


Cost Per Session: $100  
Applications postmarked prior to June 1st receive a $10 discount.
Applications postmarked after June 1st but prior to July 1st receive a $5 discount.
Send your application in the same envelope along with two of your friend's applications, and receive an additional $5 off each campers fee.
Payments are non refundable.
All campers must supply insurance information.
Campers must supply their own lunch.
Make checks or money orders payable to: NextLevel Hoops  
Mail to: NextLevel Hoops, 233 South Main Street, Forest City, PA 18421
You may make as many additional copies of the enclosed information and applications as you may require.  
After receiving your application, directions and list of items needed for camp will be emailed to you.