Ace Salu's FAST Basketball Clinics Registration:

All fields (except comments) must be completed for the form to work.

November - December 2009, January 2010

Mondays and Tuesdays: 5:30-7:00 pm
Sundays: 12:30-1:45 pm

Developing fundamentals skills, shooting, and ball handling techniques

• Cost:
• Monthly Training:
  • Paying with Paypal: $130.00
    
  • Paying with check: $125.00
• Walk-in: $25.00 per day

• Location:
  
  • St. Agatha Gymnasium
    7960 Southeast 15th Avenue
    Portland, OR 97202

Registration now for Ace Salu's FAST Basketball Clinic

	November 2009 all access  December 2009 all access  January 2010 all access
Player's Name
Age	Current Grade
School
Parents Name
Address
City, State, Zip
Daytime Phone
Home Phone
E-Mail
In case of emergency, please contact:
Name
Contact Phone
Relationship to child
Additional Comments
	We like to take pictures! If you do not want your child photographed for our website and future promotional materials, please check the box.
Help Us Grow! Please let us know how you heard of us:

This is to certify that the above-named child has had a physical examination by a licensed physician within the last six (6) months and is free from any illnesses, injuries, or conditions which could inhibit the child from activities of the camp. I will notify coaches prior to the camp or clinic of any physical conditions that may inhibit play.

I hereby release the Pacific Islands Council of Oregon, its staff and sponsors from any and all liability (present and/or future) for injuries that may be incurred by my child while participating in camp activities. (A "NO" reply will not allow your child to participate.)
Yes No

X
(Please type name to serve as signature of parent or guardian)

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NOTE: Camp fees will not be refunded or pro-rated.

Please print this form for your records before you hit "Continue to Payment."

2010 Football camp registration will open April 2010