Voyageur Basketball Academy
for Kids at Laurentian University
May 9 – June 20, 2015
4 - 9 years old 10am-11am
10-13 years old 11am-noon
FEE: $75.00 bring form and payment on first day
or pre-pay by providing credit card # _______________________________ exp_________
Last name
First name
Address
Home phone:
E-mail address
Guardian/parent
Work phone
Cell phone
Guardian/parent
Work phone
Cell phone
Please enter current school grade:
Current School name
T-Shirt Size: small
medium
large
Age
x-large
Consent to participate:
I understand that participation in any sports activity involves a certain degree of risk. After considering the risks
involved and having confidence that reasonable precautions would be taken to ensure the safety and well-being
of my child, I grant permission for my daughter or son to participate in the league.
Signature of parent/guardian
Date
Privacy Policy
The Voyageur Basketball Academy for Kids will not share any of the above information with any other organization except
Basketball Ontario without the written consent of the parent/guardian.