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Mass Ducks Offensive Attack Clinic Registration |
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Players Name |
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Gender |
Female Male |
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Grade (Next Sept) |
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Date of Birth |
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Clinic
(Please indicate which clinic)
**** PLEASE NOTE: AGES ARE
BASED ON WHAT GRADE PLAYER WILL BE ENTERING IN
SEPTEMBER 2010**** |
Girls Grades 3-6:
Wednesday and Friday nights 5:00 – 7:00pm
Girls Grade 7: Monday and Thursday
nights 5:00 – 7:00pm
Girls Grade 8: Wednesday and
Friday nights 7:00 – 9:00pm
Girls Grade 9: Monday and Thursday
nights 7:00 – 9:00pm
Girls Grades 10-12: Tuesday and
Sunday nights 7:00 – 9:00pm
Boys Grades 4-9: Tuesday and
Sunday nights 5:00 – 7:00pm |
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Dates |
Tuesday, July 6th
– Monday August 30th |
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Home Phone |
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Cell Phone |
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Emerygency
Contact |
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Emergency Phone |
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Address |
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City/Town |
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Zip |
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Email 1 |
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Email 2 |
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T-Shirt Size |
Youth M
L XL
Adult S M L XL XXL |
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Medical Insurance
Carrier |
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Any
Medical Conditions we should be made aware of: |
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Clinic Info |
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Location |
Milton/Quincy
area |
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Cost |
$260 Per Player
(Less than $8.15 per hour) |
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Discounts
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$30 off for Mass
Ducks AAU Players
$15 off for Siblings |
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Checks Payable To |
Mass Ducks |
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Mailing Address |
Mass Ducks AAU
C/O Dan Norton
112 Homeland Drive
Whitman, MA 02382 |
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Contact Info |
Email: massducks@comcast.net
Phone: Dan Norton 781-264-5613 |
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Parent/Guardian Must Sign the Following:
(If filling out the form electronically,
please print your name for an electronic
signature). |
The applicant is in good
health and able to participate in the physical
activity of a vigorous program. The clinic has
my permission to provide emergency medical care
in the event my daughter is injured or ill. I
also release the camp directors and staff from
any liability
Signature: |