Wyoming Valley Clutch 2022 Summer Basketball Camp

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Wyoming Valley Clutch Basketball Camp - June 27th thru 30th - 9:00 AM to 2:00 PM
Open to Boys & Girls Grades 1st - 9th
$175 Per Participant (includes lunch and swimming each day)

For more information contact:
Chris Shovlin @ 570-235-8780 or Dave Jannuzzi @ 570-574-1865

Email *

Camper Information

First Name *

Last Name *

Gender *

Female

Male

Grade *

Shirt Size *

Date of Birth *

School *

Street Address *

City *

State *

Zip Code *

Parent/Guardian Name *

Phone Number *

Emergency Contact (Name) *

Emergency Contact Number *

Waiver

I, the parent/guardian of the registrant, a minor, do agree and will abide by all the rules of the Wyoming Valley Clutch LLC & Catholic Youth Center (CYC). l recognize the possibility of physical injury associated with participating in Wyoming Valley Clutch LLC & CYC sponsored activities, and in consideration for the Wyoming Valley Clutch LLC & CYC providing these activities, do release the Wyoming Valley Clutch LLC & CYC and its staff members from all liability for any injuries sustained while on CYC property and/or participating in CYC activities.

Waiver Acceptance *

Yes, I agree.

Required

Send me a copy of my responses.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms