WestConn's Basketball Clinic with Head Coach Guy Rancourt
DATE: Saturday, March 30 OR Sunday, March 31
TIME: Grades: K-8: 10-12pm / Grades: 9-12: 1-3pm
ADDRESS: The O'Neill Center 43 Lake Ave Ext. Danbury, CT
Saturday March 30 10-12pm (grades K-8)
Saturday March 30 1-3pm (grades 9-12)
Sunday March 31 10-12pm (grades K-8)
Sunday March 31 1-3pm (grades 9-12)
Date of Birth
Emergency Contact (Name/Relationship/Phone)
I certify that the applicant is in excellent physical health and is capable of participating in a strenuous activity, with basketball. I also agree to hold harmless the directors as stated above, Western Connecticut State University, it’s staff, agents, host site and employees from any and all injuries sustained by the participant during his/her participation. In case of emergency, I grant permission for the applicant to be given treatment at a local hospital. Any expense arising from injury or illness is the responsibility of parental insurance coverage. I have read and fully understand this release statement.
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