It's easy to register.  Just print out this application form, complete it and mail to:
Bob Koch · 1934 Bleim Rd · Sanatoga, PA · 19464

Female POINT GUARD ACADEMY 2008 Application

Please the appropriate box 

Session I:   August 10-13            Commuter  Dorm Resident
 

Name__________________________________________________________________________________

Address________________________________________________________________________________

City___________________________________________________State________ Zip_________________

Home phone (     ) _______________________             Age (as of 6/08)___________________________

Height___________ Weight_________    Date of Birth ____ / _______/ ____ Year of HS Graduation:________

School______________________________School Address ____________________________________

City____________________________  State_______  Zip Code______________

How did you hear about the Academy?___________________  Please send me ________additional brochure(s)

Enclosed is_______Deposit                                               Enclosed is Full Payment
                                                                                                  Cirlce One:  Resident: $470 - Commuter $275

T-Shirt Size: _____Medium    _____Large    _______X-Large

Roommate Preference______________________________ Please check one _____Commuter _____Resident

Health Insurance Information: Company Name__________________________________

Policy Number___________________________   Group Number____________________

Allergies to Medicine:__________________________
Acceptance:  After your registration is received, you will be sent a letter of acceptance and additional information.

In Case of Emergency-

I hereby authorize the staff of Koch's Point Guard Academy to act for me according to their best judgment in any emergency requiring medical attention and I hereby waive and release the Academy from any and all liability for any injuries or illness incurred while at the Academy.  I have no knowledge of any physical impairment that would be affected by the above named participant's participation in the academy program, as outlined in the brochure.  I also understand the academy retains the right to use for publicity and advertising purposes, photographs of participants taken at the academy.

Parent/Guardian signature____________________________________