Mark Beinborn's Girls Basketball Camps 2014

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 GIRLS –June 16th thru June 19th Grade Entering Fall 2014 (3-6):______ Day Camp – 9:00 AM to 3:00 PM (Monday through Thursday)

Mark Beinborn’s Girls Basketball Camps 2014

 GIRLS –June 23rd thru June 26th Grade Entering Fall 2014 (7-12):______ Day Camp – 9:00 AM to 3:00 PM (Monday through Thursday)

** TO ENSURE A QUALITY EXPERIENCE – REGISTRATION IS LIMITED.** Registration & Fees :

 GIRLS –June 16th thru June 19th

Entering Fall of 2014(Grades 3-6): _______(Grade)

$130.00

Day Camp – 9:00 AM to 3:00 PM (Monday through Thursday) Registration deadline June 9th……….After June 9th, $5 late fee

GIRLS –June 23rd thru June 26th Entering Fall of 2014(Grades 7-12):_______(Grade)

$130.00

All Sessions include: T-Shirt & Basketball

Day Camp – 9:00 AM to 3:00 PM (Monday through Thursday)

Instructional Staff: Coach Beinborn and his assistant coaches, professional coaches from other successful programs, and college players (varies per session).

Registration deadline June 16……….After June 16, $5 late fee

****MAKE CHECKS PAYABLE TO MARK BEINBORN**** Last Name, First, M.

Home Address (Street, City, Zip)

Where to Report: All students are to report to PepsiCo Recreation Center. Registration Fees: May be paid directly to: Mark Beinborn, 639-38th St., Rock Island, IL 61201

Age:

Shirt Size (Adult):

Name of School Entering in Fall of 2014

 S  M  L  XL Telephone:

*Signature of Parent or Guardian (Must be signed)

Lunch: Campers must bring their own lunches. Beverages and snacks can be purchased on site.

E-Mall Address: *INSURANCE: Students must have their own health insurance. The parent(s)/guardian(s) signature above releases Augustana College, Coach Mark Beinborn, and the staff from accident and injury liability. *DEPOSIT: A $60.00 non-refundable deposit is required before confirmation on all camps. *REFUNDS: Will be made for medical reasons only … Not for change of plans. For additional information or applications, please call (309) 794-8255. Mail form and the pre-registration fee payable to: Mark Beinborn, 639-38th St., Rock Island, IL 61201 FOR OFFICE USE ONLY;

Date Received:

Insurance: Students must have their own health/accident insurance. The parent(s) signature releases Augustana College, Coach Mark Beinborn, and the staff from accident and injury liability.

Amount Received:

Balance Due:

Merchandise: All campers receive a camp t-shirt and basketball included in their registration fee. Augustana College Basketball apparel will available to purchase on site.