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Application
Please fill in the form and use the PRINT button below to print the application.
Mail the application with fee payable to:
Mike Gosz - 276 Nob Hill East - Colgate, WI 53017
Phone: (262) 510-5101 -
Email: This e-mail address is being protected from spambots. You need JavaScript enabled to view it
Personal Information
Last:
First:
M.I.
HT.
Address
Street
City
State
Zip
Phone
Email
Miscellaneous
School attending
Grade
1
2
3
4
5
6
7
8
9
(Fall of 2012)
Age at camp
Male
Female
Adult shirt size
Small
Medium
Large
Extra Large
Camps & Fees
June 18-21
Fundamental Camp
@ Hamilton High School, Sussex
First family member: $80.00
Each additional family member: $70.00
June 25-28
Fundamental Camp
@ St. Mary's, Menomonee Falls
First family member: $80.00
Each additional family member: $70.00
July 9-12
Basketball Academy
@ UW-Waukesha
Each additional family member: $175.00
Each additional family member: $150.00
July 17-19
Shooting/Offensive Skills Camp
@ Hamilton High School, Sussex
First family member: $70.00
Each additional family member: $60.00
Package (Make sure to choose dates above)
Fundamental & Shooting Camp: $135.00
Waiver
I hereby authorize the personnel of the 2012 Mike Gosz Basketball Camp to act for me according to their best judgment in any emergency requiring medical attention. I hereby release the camp, its affiliates, and all agents from any and all liability for any injuries sustained while at camp.
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Parent or Guardian Signature
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Date
Copyright 2012 © Don Gosz Basketball Camp. All rights reserved.