Teaches Basketball Camps LLC

Summer Camp Sign-up Sheet

(Please Print out this Form)
Name of Participant:                                                                                                                           
Name of Parent(s)/Guardian(s):                                                                                                       
Day Phone:                                                          Evening Phone:                                                   
Address:                                                                                                                                                
Town:                                                                                                    Zip:                                         
Name of Emergency Contact:                                                                                                            
Emergency Contact Phone:                                                               Age:                                        

Starts

 Town Location Times Grades Price Kids (#) Total
2/17 Armonk Coman Hill School 9:00-12:00 K-2 $130
2/17 Armonk Crittenden School 9:00-2:30 3-7 $175
2/17 Briarcliff Todd School 9:00-12:00 1-2 $125
2/17 Briarcliff Briarcliff Middle School 9:00-2:30 3-8 $165
2/17 Chappaqua Grafflin School 9:00-12:00 1-2 $130
2/17 Chappaqua Bell School 9:00-2:30 3-7 $175
2/17 Lewisboro John Jay Middle School 9:00-2:00 7-15 (ages) $185
4/5 Armonk Crittenden School 9:00-2:30 3-8 $175
4/5 Briarcliff Todd School 9:00-12:00 K-2 $125
4/5 Briarcliff Briarcliff Middle School 9:00-2:30 3-8 $165
4/5 Chappaqua Grafflin School 9:00-12:00 1-2 $130
4/5 Chappaqua Bell School 9:00-2:30 3-7 $175
4/5 Edgemont Greenville Elem. School 9:00-2:30 3-8 $175
4/5 Lewisboro John Jay Middle School 9:00-2:00 7-15 (ages) $185
4/12 Edgemont Greenville Elem. School 3:10-4:30 3-6 $175
4/13 Chappaqua Grafflin School 4:30-6:00 1-3 $175
4/14 Armonk*** Coman Hill School 3:15-4:45 1-4 $175
4/14 Bedford Bedford Elementary 4:30-6:00 1-3 $175
4/15 Edgemont Greenville Elem. School 3:10-4:30 1-2 $175
4/15 Rye Brook Ridge Street School 4:45-6:00 K-3 $175
4/20 Greenburgh Highview School 3:30-5:00 K-3 $95
5/17 Greenburgh Woodlands H.S. 6:00-8:00 8-17 (ages) $140
Total: $            
* Players Camp (See Summer Schedule for more information)
** "Little Hot Shots" (See Summer Schedule for more information)
*** Girls Only Camp!
Camp fees vary due to different overhead and operating cost at each location. 
To Sign-up for camp, please check the applicable box(es) and mail with check or money order to the address below.  Please make all checks payable to Terry Teachout.
Teaches Basketball Camps LLC
59 South Greeley Avenue
Chappaqua, New York 10514
Waiver of Liability:  I understand that injuries are inherent with a sport activity.  In the event that an injury occurs to myself or a family member, I agree not to hold Teaches Basketball Camps LLC and the sponsor, and any person connected with Teaches Basketball Camp LLC or the sponsor liable for any and all claims for bodily injury and property damage arising from participation in Teaches Basketball program or camp.
Parent Signature:                                                                                                                                 

Date: