WHO:
7th - 9th graders interested in Basketball
WHERE:
Brimhall Junior High
WHAT:
Basketball Skill Development
WHEN:
_____ $75
7th - 9th graders
May 27 - June 26
2:30-4:30 pm
CONTACT:
Darris Schomaker @ 472-2592
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 TO PAY ONLINE CLICK HERE: www.mpsaz.org/pay Then click on Sports Camps

------------------------Cut and return here or pay on-line------------------------


_____ $75
7th - 9th graders
May 27 - June 26
2:30-4:30 pm

Contact Darris Schomaker @ 472-2592
Account # - 261-1303
TO PAY ONLINE CLICK HERE: www.mpsaz.org/pay
Then click on sports camps.
I give permission for my child to participate in the camp listed. I understand all risks and hazards
incidental to 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