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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:
Jim Gosz - 6934 W. Norwich St. - Milwaukee, WI 53220
Phone: (414) 546-0201 -
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 2011)
Age at camp
Male
Female
Camps & Fees
June 27-30
Shooting/Offensive Skills @ St. Monica
$100.00 enclosed
After June 20: $110.00 enclosed
June 27-30
Post/Perimeter @ St. Joseph
$100.00 enclosed
After June 20: $110.00 enclosed
July 11-14
Complete Skills @ Blessed Sacrament
$100.00 enclosed
After July 4: $110.00 enclosed
July 11-14
Basketball Academy @ Blessed Sacrament
$200.00 enclosed
After July 4: $210.00 enclosed
July 18-21
Basketball Academy @ St. Leonard
$200.00 enclosed
After July 11: $210.00 enclosed
July 25-28
Shooting/Offensive Skills @ Blessed Sacrament
$100.00 enclosed
After July 18: $110.00 enclosed
July 25-28
Post/Perimeter Camp @ Blessed Sacrament
$100.00 enclosed
After July 18: $110.00 enclosed
Waiver
I hereby authorize the personnel of the 2011 Jim Gosz Basketball Camp to act for me according to their best judgment in any emergency requiring medical attention. I hereby waive and release the camp, its affiliates, and all sponsoring and assisting employees and agents from any and all liability for any injuries incurred while at camp.
________________________
Parent or Guardian Signature
________________________
Date
Copyright 2012 © Don Gosz Basketball Camp. All rights reserved.