WHO:	All Ages
WHERE:	Stapley Junior High School Gym
WHAT:	Basketball skill development
WHEN:	______ $40 per week ______ $150 for all 4 weeks 9th graders Mon - Thur 1:00-3:00 June 2-June 26 ______ $30 per week ______ $110 for all 4 weeks 6th - 8th graders Mon - Thur 3:00-4:30 June 2-June 26 ______ $20 per week ______ $70 for all 4 weeks K-5th graders Mon - Thur 4:30-5:30 June 2-June 26
COACHES:	John Huckelberry @ 472-2746
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---------------------------------

______ $40 per week ______ $150 for all 4 weeks	9th graders	Mon - Thur	1:00-3:00	June 2-June 26
______ $30 per week ______ $110 for all 4 weeks	6th - 8th graders	Mon - Thur	3:00-4:30	June 2-June 26
______ $20 per week ______ $70 for all 4 weeks	K-5th graders	Mon - Thur	4:30-5:30	June 2-June 26

John Huckelberry @ 472-2746 - jchuckel@mpsaz.org
Account # 262-1303
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