Application

Please fill in the form and use the PRINT button below to print the application.
Mail the application with fee payable to:
Mike Gosz

276 Nob Hill East

Colgate, WI 53017

Personal Information

Last:

First:

M.I.

HT.

Address

Street		City
State		Zip
Phone		Email

Miscellaneous

School attending	Grade (Fall of 2021)
Age at camp
Gender	Male Female
T-shirt size
Have you previously attended a Mike Gosz Basketball Camp	Yes No

Camps & Fees

June 14-17, 2021 Fundamental Camp @ St. Mary's, Menomonee Falls		First family member: $90.00
		Each additional family member: $80.00
June 21-24, 2021 Offensive Skills Camp @ St. Mary's, Menomonee Falls		First family member: $90.00
		Each additional family member: $80.00
July 5-8, 2021 Basketball Academy @ St. Dominic's, Brookfield		First family member: $185.00
		Each additional family member: $165.00
July 13-15, 2021 Shooting Camp @ Hamilton High School, Sussex		First family member: $90.00
		Each additional family member: $80.00

WaiverI hereby authorize the personnel of the 2021 Mike Gosz Basketball Camp to act for me according to their best judgment in any emergency requiring medical attention. I hereby release the camp, its affiliates, and all agents from any and all liability for any injuries sustained while at camp.

________________________
Parent or Guardian Signature
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Date