Print the registration form on your printer and send it to the address on the form.

   Registration Form   
HEAD  START  BASKETBALL  HOLIDAY  CAMP
AT ST. PASCHAL BAYLON SCHOOL IN HIGHLAND HEIGHTS 
DECEMBER 27 & 28, 2007:   1:00 - 4:00 p.m.
for boys and girls in grades 1-6


Name_________________________________Phone Number_______________

Address______________________ City_________________ Zip Code_______

Grade __________School Attended______________ Email Address_________

December 27 & 28, 2007 - St. Paschal Baylon School, 5360 Wilson Mills Road,
Highland Heights  (1:00 - 4:00 p.m.) ____________________



I, the undersigned (parent or guardian) do hearby release and waive any and all  rights and claims I may have against Head Start Basketball, Inc., its shareholders, employees, and the St.  Paschal Baylon Church & School  regarding injuries suffered by my son or daughter while enrolled in the HEAD START BASKETBALL HOLIDAY CAMP.

Parent or Guardian signature

______________________________________________________Date_____________________________

The cost to enroll in the HEAD START BASKETBALL HOLIDAY CAMP is $40.  Please make check or money order payable to Head Start Basketball, Inc. and send to Head Start Basketball, Inc., 12017 The Bluffs, Strongsville, OH 44136.

For more information call (440) 268-0457.