2019 St. John's Mukwonago Basketball Camp Registration Form
What: St. John's Mukwonago is offering a summer basketball camp for 1st-6th grade.

Where: At St. John's Lutheran School gym (410 Veteran's Way Mukwonago, WI 53149)

When: June 17th-June 20
1st-3rd grade will meet from 12:00 pm - 2:00 pm
4th-6th grade will meet from 2:00 pm - 4:00 pm

Cost: $15 per child

For more information, please call the St. John's office at: 262-363-4999.

*Please fill out one for per child*

What is your child's name (Last, First)? *
Your answer
What is your child's birth date? *
MM
/
DD
/
YYYY
What grade is your child attending in the 2019-2020 school year? *
(grade going into)
Child's T-shirt Size *
Parent/Guardian name (Last, First) *
Your answer
Street Address (Street, City, Zip code) *
Your answer
Primary Phone *
Your answer
Email Address
Your answer
Please list emergency contact: name, phone number, and relationship *
Your answer
Do you have a church home? *
If you do, which church do you regularly attend?
Your answer
St. John's basketball camp leaders have permission to photograph/film the minor(s) designated above for any lawful purpose associated with this basketball program. *
Please list any allergies, special needs, or other concerns.
Your answer
St. John's Basketball camp costs $15 per child. Please pay by mail or stop in the front office before June 17th. Payable by check or cash. Please write check to St. John's and include child's name being paid for. Mailing Address: St. John's Basketball Camp 410 W. Veteran's Way, Mukwonago, WI 53149 *
Any additional comments or questions for us?
Your answer
PERMISSION Waiver
The undersigned parent/guardian acknowledges that there are dangers and risks of injury inherent in sports activities, but still allows his/her child to participate in the basketball camp at St. John’s. THEREFORE, the undersigned, to participate in the St. John's Basketball, does hereby accept full responsibility for liability and cost of treatment of injury to the above registered person. The undersigned does hereby release the teachers/coaches/assistants and St. John's Lutheran School and Church from all liability resulting from negligence and agrees to hold them harmless for any injuries and/or damages his/her child may sustain arising out of the activities inherent in a basketball camp. *
Please give your electronic signature by typing your full name below.
Your answer
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