SPRINGFIELD BASKETBALL ACADEMY 2010 Training Sessions Registration Form (Print in Landscape)

Grade _______________ School _______________________________ DOB _______________ Male _____ Female _____ Name _____________________________________ Parent's Name ______________________________________________ Address ____________________________________ City, State, Zip ____________________________________________ Mom's H: _______________________ Mom's W: _________________________Mom's Cell: _________________________ Dad's H: _______________________ Dad's W: _________________________ Dad's Cell: ____________________________ Fax Number _________________________ Email Address: ____________________________________________________ ALL CONFIRMATIONS WILL BE MADE VIA EMAIL Select from the following season(s) _____ Spring Session (10 sessions April 20– May 20) $109 ~ Tuesday & Thursday Evenings _____ Summer Session (10 sessions June 8 – July 8) $109 ~ Tuesday & Thursday Mornings/Afternoons _____ BEST VALUE – Both Sessions (20 sessions) $199