Eastside Basketball Association

EASTSIDE
BASKETBALL ASSOCIATION

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1ST AND 2ND GRADE INTRODUCTION TO BASKETBALL CLINIC
FOUR SATURDAYS FROM 1:00-2:30PM
MARCH 1st, 8th, 15th, 22nd 2008
PERINTON COMMUNITY CENTER 1350 TURK HILL RD.
*** BOYS AND GIRLS ***
***$75 REGISTRATION FEE ***
Note: All participants should bring a 28.5 girls size basketball to clinic.

FILL OUT INFORMATION BELOW PRINTOUT AND MAIL TO:
KEVIN LEGG // 871 MACEDON CENTER ROAD // FAIRPORT, NEW YORK 14450
Phone 585.425.1883
Make checks payable to Eastside Basketball Association.
YOUR CANCELLED CHECK WILL BE PROOF OF ENROLLMENT

GRADE: DOB: AGE

MOTHER'S NAME:
PHONE NUMBER:

FATHER'S NAME:
PHONE NUMBER:

ADDRESS:
E-MAIL ADDRESS:

DOCTOR:
PHONE NUMBER:

EMERGENCY CONTACT:
PHONE NUMBER:

SPECIAL CONDITIONS:

I hereby give permission for my child
to participate in the EASTSIDE BASKETBALL PROGRAM. I understand and agree that I am responsible for insurance coverage and neither the Eastside Basketball Program, Supervisors, or the associated facility may be held liable for any injury to my child while participating in the program.

SIGNATURE: ________________________________ DATE:

Kevin Legg - klegg@esbasketball.com or 585-425-1883

Eastside Basketball Association

EASTSIDE BASKETBALL ASSOCIATION
871 Macedon Center Rd., Fairport, New York 14450
Fax 585-421-9025 - Phone 585-425-1883
E-Mail klegg@esbasketball.com
E-Mail comments to: webmaster@esbasketball.com