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:                                         Email:                                                        
Name of Emergency Contact:                                                                                                                                                                            
Emergency Contact Phone:                                                                                                         Age:                                                              

Date

Town Location Times Kids (#) Price Total
6/28 - 7/2 Elmsford Hamilton H.S. 9:00 - 2:30 $150
7/5 - 7/9 Armonk Byram Hills H.S. 9:00 - 2:30 $200
7/12 - 7/16 Armonk Byram Hills H.S. 9:00 - 2:30 $200
7/12-7/16 Girls Only St. Pat's - Armonk† 9:00 - 4:00 $275

7/12-7/16 Garrison Garrison School 9:00 - 3:00 $125

7/19 - 7/23 Chappaqua Horace Greeley H.S.* 9:00 - 2:30 $225
7/19 - 7/23 Ohio Kenston M.S. 9:00 - 2:30 $199
7/19 - 7/23 Somers Somers H.S. 9:00 - 2:30 $200

7/26 - 7/30 Armonk Byram Hills H.S.* 9:00 - 2:30 $225
7/26 - 7/30 NYC Streetballers St. Pat's - Armonk† 9:00 - 4:00 $325
8/2 - 8/6 Rye Brook Ridge Street School 9:00 - 2:30 $200

8/2 - 8/6 Yorktown Yorktown H.S. 9:00 - 2:30 $200

8/9 - 8/13 Chappaqua Horace Greeley H.S. 9:00 - 2:30 $200
8/9 - 8/13 Chappaqua Bell School - Soccer*** 9:00 - 2:30 $175
8/9 - 8/13 Edgemont Edgemont H.S. 9:00 - 2:30 $200
8/16 - 8/20 Chappaqua Bell School 9:00 - 2:30 $200

8/16 - 8/20 Chappaqua Grafflin Elementary** 9:00 - 12:00 $140

8/23-8/27 Ossining Community Ctr. 12:00 - 5:00 $150

8/29-9/2 Ossining Community Ctr. 12:00 - 5:00 $150

8/22 - 8/25 Pittsfield, MA Camp Winadu Sleep Away
Before 8/1		 $425

8/22 - 8/25 Pittsfield, MA Camp Winadu Sleep Away
After 8/1		 $450

Total: $            
* Players Camp (See Summer Schedule for more information)
** "Little Hot Shots" (See Summer Schedule for more information)
***Super Stars Soccer (See Super Stars Soccer for more information)
†Camp is held in the air conditioned St. Pat's Church (See "Summer Girls Only" and "NYC Streetballers" links for more info)
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: