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
Phone: (262) 510-5101 - Email: This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Personal Information

Last:

First:

M.I.

HT.

Address

Street		City
State		Zip
Phone		Email

Miscellaneous

School attending	Grade (Fall of 2019)
Age at camp
Gender	Male Female
T-shirt size
Have you previously attended a Mike Gosz Basketball Camp	Yes No

Camps & Fees

June 17-20 Fundamental Camp @ St. Mary's, Menomonee Falls		First family member: $90.00
June 17-20 Fundamental Camp @ St. Mary's, Menomonee Falls		Each additional family member: $80.00
June 24-27 Fundamental Camp @ Hamilton High School, Sussex		First family member: $90.00
June 24-27 Fundamental Camp @ Hamilton High School, Sussex		Each additional family member: $80.00
July 8-11 Basketball Academy @ St. Dominic's, Brookfield		First family member: $185.00
July 8-11 Basketball Academy @ St. Dominic's, Brookfield		Each additional family member: $165.00
July 16-18 Shooting/Offensive Skills Camp @ Hamilton High School, Sussex		First family member: $90.00
		Each additional family member: $80.00

WaiverI hereby authorize the personnel of the 2019 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.

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Parent or Guardian Signature
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Date