2021 APPLICATION FORM
(Please print out this form and send with your enrollment check)
FULL DAY SESSION (8:30am - 2:30pm) - $395
1/2 DAY SESSION (8:30am - 12:00 noon) - $315
Because we have seen the benefits to our participants of attending more than one week of instruction,
we are offering $25 off the enrollment fee for a second week
Session 1 - Monday July 19 - Friday July 23 in Harwich @ Monomoy Regional High School
Session 2 - Monday July 26 - Friday July 30 in Harwich @ Monomoy Regional High School
Session 3 - Monday August 2 -Friday August 6 in Harwich @ Monomoy Regional High School
Check: Session 1 ____ Session 2 ____ Session 3 ____
Full Day ____ 1/2 Day ____
(If attending multiple sessions, please check each session desired)
Name: ______________________________________________________
Age: _______ Male _____ Female _____
Email Address: ______________________________________________
Mailing Address: _____________________________________________
City: _______________________________________________________
State: ___________________________________ Zip Code: ___________
School: ____________________________________ Grade: ___________
Home Phone: ________________ Emergency Phone: __________________
Insurance Carrier: _____________________________________________
T-Shirt Size: ______________
Please enroll my son/daughter in your Mid-Cape Hoop School. I understand that the Monomoy Regional School District,
Mid-Cape Hoop School co-directors, staff or anyone associated with this camp will not assume responsibility for accidents and medical or dental expenses incurred as a result of participation in this program. The applicant is covered by our family insurance, is in good health and able to participate in the physical activity or a vigorous program. I, hereby, authorize the camp directors to act for me according to their best judgment in any emergency requiring medical attention.
PARENT'S SIGNATURE:X_______________________________________________ DATE____/____/____
Send Form & Non-Refundable Tuition or $100 Deposit Payable To:
(Balance Due Prior to Participating)
Mid-Cape Hoop School
c/o Bob Hamilton
40 Sheffield Road
West Yarmouth, MA 02673
508-394-4039 rhamilton08@comcast.net