WHO:	All Ages
WHERE:	Stapley Junior High School Gym
WHAT:	Basketball skill development
WHEN:	______ $30 6:00-7:00 -Wednesday Nights April 1 - May 8
COST:	$30 FOR BASKETBALL CAMP
COACHES:	John Huckelberry @ 472-2746 and Rory Richeson
SIGN UP:	Complete the registration form below and mail with check, money order or credit card information to the address at the bottom of the page or: PAY ONLINE CLICK HERE: www.mpsaz.org/pay

-----------------------------cut along line and mail or pay on-line---------------------------------

______ $30

6:00-7:00 -Wednesday Nights

April 1 - May 8

$30 per session
John Huckelberry @ 472-2746 - jchuckel@mpsaz.org
PAY ONLINE CLICK HERE: www.mpsaz.org/pay
I give permission for my child to participate in the camp listed. I/we understand all risks and hazards incidental to
such participation and do hereby waive, release, absolve, indemnify and hold harmless Mesa Public Schools
and the school from any claim arising out of any injury to my child.

Student Name:	.	(H) Phone:
Parent/ Guardian:	.	(W) Phone:

Address:

City:

Zip:

Amt. Paid : __________

Credit Card: ______Visa ______Mastercard __________________________________

Exp. Date:: __________

3 Digit Code: __________

Checks must be made payable to : Mesa Public Schools.
Mail to: Mesa Public Schools - Accounting CE, 63 East Main #101, Mesa, Az. 85201