Youth Basketball Clinic

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Learn fundamental basketball skills. * December 4,11,18 (Wednesdays) * 6:00 pm - 6:25 pm --- 3 & 4 year olds * 6:30 pm - 7:00 pm --- 5 & 6 year olds * Clearwater Middle School Gym * Registration fee includes t-shirt and basketball

Instructional Clinic

Child's Name*

First Last

Age*

Shirt size*

Parent/Guardian's Name*

First Last

Parent/Guardian's Phone (area code + phone number)*

Parent/Guardian's Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Parent/Guardian Signature*

Total

This includes online convenience fee.

Payment Method

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

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