Becker Middle School
2010 Summer Schedule

Ready, Set, Play Basketball Clinic

Please note that all fields followed by an asterisk must be filled in.

Athlete's First Name*
Athlete's First Name*

Athlete Last Name*
Athlete Last Name*

Athlete's Birthdate*
Athlete's Birthdate*

Gender*
Gender*

Do You Have Health & Accident Insurance?*
Do You Have Health & Accident Insurance?*

	Yes
	No

Is Your Child An "AAU Member"?*
Is Your Child An "AAU Member"?*

	Yes
	No

E-mail Address*
E-mail Address*

Street Address*
Street Address*

City*
City*

State/Prov*
State/Prov*

Zip/Postal Code*
Zip/Postal Code*

Home Phone*
Home Phone*

Business Phone*
Business Phone*

6 Sessions "Basic Skills &Game"

Saturdays 9:00 a.m. - 10:30 a.m.