WHERE:
Mesa High School Gym - Home of 13 State Basketball Titles
WHEN:
______$35
____6/2-12
____6/16-26
 K-2 grade 8:00-9:00
______$35
____6/2-12
____6/16-26
 3-5 grade 9:00-10:30
______$35
____6/2-12
____6/16-26
 6-8 grade 10:30-12:00
______$35
____6/2-12
____6/16-26
 9-12 grade 12:00-1:30
CONTACT:
Head Coach Shane Burcar - 231-9056
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 click on sports camps
--------------------------Pay online or cut here and return lower half with payment------------------

______$35
____6/2-12
____6/16-26
 K-2 grade 8:00-9:00
______$35
____6/2-12
____6/16-26
 3-5 grade 9:00-10:30
______$35
____6/2-12
____6/16-26
 6-8 grade 10:30-12:00
______$35
____6/2-12
____6/16-26
 9-12 grade 12:00-1:30
Contact: Head Coach Shane Burcar - 231-9056 -Account # 271-1303
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