2017

APPLICATION FORM 2017
(Please print out this form and send with your enrollment check)

FULL DAY SESSION (8:30am - 2:30pm) - $320
1/2 DAY SESSION (8:30am - 12:00 noon) - $280

Because we have seen the benefits to our participants of attending more than one week of instruction,
we are offering $25 off the enrollment fee for a second week

Session 1 - Monday July 10 - Friday July 14 @ Dennis-Yarmouth Regional High School
Session 2 - Monday July 17 - Friday July 21 @ Dennis-Yarmouth Regional High School
Session 3 - Monday July 24 - Friday July 28 in Chatham @ Monomoy Regional Middle School

Check:   Session 1 ____       Session 2 ____    Session 3 ____
Full Day ____     1/2 Day ____
(If attending multiple sessions, please check each session desired)

          Name: ______________________________________________________
          Age: _______      Male _____      Female _____
          Email Address: ______________________________________________
          Mailing Address: _____________________________________________
          City: _______________________________________________________
          State: ___________________________________ Zip Code: ___________
          School: ____________________________________ Grade: ___________
          Home Phone: ________________ Emergency Phone: __________________
          Insurance Carrier: _____________________________________________
          T-Shirt Size: ______________

Please enroll my son/daughter in your Mid-Cape Hoop School. I understand that the Dennis-Yarmouth Regional School District, Monomoy Regional School District, Mid-Cape Hoop School co-directors, staff or anyone associated with this camp will not assume responsibility for accidents and medical or dental expenses incurred as a result of participation in this program. The applicant is covered by our family insurance, is in good health and able to participate in the physical activity or a vigorous program. I, hereby, authorize the camp directors to act for me according to their best judgment in any emergency requiring medical attention.

PARENT'S SIGNATURE:

X_______________________________________________                                              DATE____/____/____

Send Form & Non-Refundable Tuition or $100 Deposit Payable To:
(Balance Due Prior to Participating)

Mid-Cape Hoop School
c/o Bob Hamilton
40 Sheffield Road
West Yarmouth, MA 02673
508-394-4039
rhamilton08@comcast.net