MCLA Women's Basketball Summer Clinic Registration

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Parent or Guardian (s) names *

Email address *

Mailing Address (Street, City, State, Zip) *

Home Phone Number *

Emergency Phone Number (during Camp Hours) *

Child's Name *

My child is entering which grade *

3rd 4th 5th 6th 7th 8th 9th

Name of school *

Insurance Company and Policy Number *

* required field