EmailMe Form - HAYC3 2012-2013 Program Fees

HAYC3 2012-2013 Program Fees

HAYC3 members receive discounts to many programs and events. If you are interested in becoming a member, please visit our "Registration" tab online. Be sure to list the number of people you are registering for. Total your fees on the right for each program, and again at the bottom. Make check payable to HAYC3 and mail to HAYC3, PO Box 492, Hoosick Falls NY 12090.

Your spot will not be reserved until payment is received. You may choose to use PayPal (link on the “Registration” page) or you may send a check to HAYC3, PO Box 492, Hoosick Falls, NY 12090. Please total your costs as you go. If you choose to pay using PayPal, simply enter your final price in the "donate" box.

Name *
First Last
Email *
Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Phone *
### - ### - ####
PROGRAMS
Include number of people who you are registering for.
Youth Basketball Program
K-2 = $25.00 (includes shirt, clinic, games, awards, and end of the year celebration)
3-6 = $35.00 (includes team shirt, clinic, practices, games, awards, open gym, and end of the year celebration)
7-8 = $40 (includes team shirt, clinic, practices, games, and end of the year celebration)
Shirt Sizes
# of people
Players' Heights
Please list players' names and height.
Would you be interested in volunteering?
Coach
Asst. Coach
Scorekeeper
Total
Will you be attending the Basketball clinic December 26-28, 2012? FREE
Yes
No
After School Program (K-4)
$100/month for members
Snow day program (additional $25/snow day)
Yes
No
Days of week attending:
Monday
Tuesday
Wednesday
Thursday
Friday
Total
School Vacation Enrichment Program
Please check which weeks you are registering for:
February 18-22, 2013
April 1-5, 2013
July 1-8, 2013 (4 days=$80)
July 15-19, 2013
July 29-August 2, 2013
August 12-16, 2013
August 26-30, 2013
Total
Other Programs
Babysitting Course
$15 member/$25 non
Yes
No
Saturday, October 13, 2012
Baton Lessons
FREE
Yes
No
Wednesdays starting March 18, 2013
Your gift of $30 of more could provide a free membership to a child in need. No child is ever denied access due to an inabilty to pay, thanks to community support.
TOTAL DUE
Please list your total amount due (including any donations).
CODE OF CONDUCT:
-Respect HAYC3 staff, equipment, building, and peers
-Only use appropriate language
-No bullying
-Clean up after yourself
-Actively support each other
-Be honest

By signing below, I agree to waive, release, and discharge all rights and claim in respect to damages or injuries sustained by my family, myself, or my child from training, competitive play, non-competitive play, travel to and from activities by organized transportation, and any other recreation activities, or from any other aspect of participation in activities organized by the HAYC3. I hereby give my consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Dentistry or qualified First Aid or CPR technician. This care may be given under whatever conditions are necessary to preserve life, limb, and well-being of those listed on this form.
Adult Signature
First Last
Date Time
MM / DD / YYYY
Youth Signature
First Last
Date Time
MM / DD / YYYY

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PROGRAMS

Youth Basketball Program

After School Program (K-4)

School Vacation Enrichment Program

Other Programs

Your gift of $30 of more could provide a free membership to a child in need. No child is ever denied access due to an inabilty to pay, thanks to community support.