Basketball Summer Camps 2021 Please contact Tom Tvrdy at email@example.com with any questions about these camps. Student Name* First Last Student Grade Level for 2021-2022 School Year*T-Shirt Size*Youth SYouth MYouth LAdult SAdult MAdult LAdult XLParent/Guardian Name* First Last Phone Number*Parent/Guardian Email Address* Summer Basketball Camp OptionsSelect the camp you wish to sign up for below. (Please note the grade level restrictions for each camp.)High School Team Camp: June 1-4$75For girls entering grades 9-122 - 5 p.m.Youth Camp: June 14-16$75For girls entering grades 3-59 - 11:30 a.m.Youth Camp: June 14-16$75For girls entering grades 6-812:30 - 3 P.m.Total $0.00 Payment InformationCredit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name Billing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Parental ConsentBy submitting this form, I hereby authorize the staff of the Marian Summer Camps to act for me according to their best judgment in any emergency requiring medical attention, and I hereby waive and release the school and all teachers involved for any liability and for any injuries or illness incurred while at Marian High School. I have no knowledge of any physical impairment that would affect the student named above on the information and registration form. Furthermore, I give Marian High School permission to take video or photographs of my daughter at the camps and use her image or likeness in future promotional materials.Submission InstructionsPlease do not click "Submit" more than once, or your card may be charged more than once. When a form has been successfully processed, a confirmation page will appear on this screen. You will also receive a confirmation email.