COACH MOUTON'S CHRISTMAS BREAK BASKETBALL CLINIC 2011

Ready for some Basketball???

K-8TH GRADERS, BOYS AND GIRLS

December 21, 22 and 23

9am to 12:30pm – AES Gym, Youngsville

$90 (snack included everyday)

Camper's Name: ___________________________________________________________

Parent's Name: ____________________________________________________________

Email: ________________________________

Home Phone: _____________________________ Cell: ____________________________

I hereby authorize the directors of Dr. Fundamentals Basketball Camp to act for me according to their best judgment in an emergency, and hereby waive and release the Camp and its staff from any liability for an injury or illness incurred while in camp.

Parent's Signature:                                                                                                     

Make checks payable to Eric Mouton

And mail to: 423 Roger Road

Lafayette, LA 70507