2008 Camp Application
Complete the form on-line, then click the printable form button to get a completed form
you can print for mailing with your check.
If you are applying for more than one camp, complete a separate application for each camp.
Abbreviate where necessary. DO NOT USE ALL CAPS

Last Name:      First Name:  
Address:  
City:     State:     ZIP:  
Home Phone: --  Additional Phone: --
Grade (Sept '08):     Email:

 
Health/Accident Insurance Coverage
Name of company:  
Agreement No.:      Group No.:  

 
What session(s) would you like to attend?
Session 1 - July 20-24 (Boys)
Session 2 - July 25-26 (Offensive Skills Camp/Co-Ed)
Session 3 - July 26-27 (Dave Hopla Shooting Camp/Co-Ed)
Session 4 - July 28-August 1 (Girls)
 
List the Sessions you will be attending (1, 2, 3, 4)

Session(s):  

  
Prices:
Boys or Girls session-$ 490 each
Offensive Skills or Hopla Camps-$ 230 each
Extended Day Camp-$ 340 each

Discounts:
OPTION A: Choose a boys or girls overnight session PLUS Off. Skills AND Hopla camps and save $ 100
OPTION B: Choose a boys or girls overnight session PLUS Off. Skills OR Hopla camp and save $ 75
OPTION C: Choose Off. Skills & Hopla camps together and save $ 50

TO RECEIVE ABOVE DISCOUNTS, YOU MUST PAY YOUR BILL IN FULL BY MAY 1st;
IF NOT APPLYING DISCOUNTS, $ 230 DEPOSITS MUST BE SENT IN WITH REGISTRATION FORM.

Amount Enclosed:  


 
Roommate Requests (Maximum of 3)
First Name:      Last Name:  
First Name:      Last Name:  
First Name:      Last Name:   
NOTE: Arrangments for roommate requests should be made in advance with all parties involved.
Due to dorm availability, roommate requests can not always be guaranteed.

I hereby authorize the staff of Connecticut Starters Basketball Camp to act for me according to their best
judgement in any emergency requiring medical attention, and I hereby waive and release the Camp from
any and all liability for any injuries or illnesses incurred while at Camp. I have no knowledge of any
physical impairment that would be affected by the above named camper's participation in the Camp program,
as outlined in the brochure. I also understand the Camp retains the rights to use (for publicity and
advertising purposes) photographs of campers taken at Camp.

PARENT OR GUARDIAN'S SIGNATURE: ____________________________________________________________
Please make check payable to:
THE BASKETBALL FACTORY
Mail to: P.O. BOX 904 - WALLINGFORD, CT 06492


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