UPEI PANTHERS MEN’S BASKETBALL PLAYERS PRESENT
PRE-SEASON BASKETBALL CLINICS AT
MURPHY’S COMMUNITY CENTRE
Sunday, november 8
grades 4-6 (co-ed)
2:00pm-4:00pm
Sunday, november 22
grades 4-6 (co-ed)
2:00pm-4:00pm
grades 7-9 (co-ed)
4:00pm-6:00pm
grades 7-9 (co-ed)
4:00pm-6:00pm
CLINICS WILL BE HELD AT MURPHY’S COMMUNITY CENTRE,
200 RICHMOND ST., CHARLOTTETOWN
EACH CLINIC WILL FOLLOW THIS FORMAT:
FIRST HOUR: SKILLS & DRILLS
SECOND HOUR: GAMES & COMPETITIONS
COST INFORMATION
$15 PER SESSION OR $25 FOR BOTH
SPACE WILL BE LIMITED TO 25 PARTICIPANTS PER SESSION.
THEREFORE YOU MUST PRE-REGISTER!
DEADLINE FOR NOV. 8 SESSION IS FRIDAY, NOVEMBER 6.
DEADLINE FOR NOV. 22 SESSION IS FRIDAY NOVEMBER 20.
DO NOT DELAY... REGISTER TODAY!
REGISTRATION INFORMATION FOR
PRE-SEASON CLINICS
Child’s Name:___________________________________
Household Email: ____________________________
DOB: dd __ mm __ yy __ Grade: ____
Gender ______
Current School: ______________________
Mailing Address (for tax receipt purposes): _________________________________________________________
City/Province: _______________________ Home Phone: _______________ Postal Code: _______
Health Card #: _________________
Work Phone: _____________ \Cell Phone: _____________
Medical Issues we should be aware of ____________________________________________________________
PAYMENT INFORMATION: We accept CASH, DEBIT, CREDIT as method of payment.
If paying by VISA, MASTERCARD OR AMEX, please fill out the following:
Card Number: _______________________________________________ Expiry ________
Signature: _______________________________________________________
WAIVER & RELEASE: I hereby give my consent and approval to the participation of the applicant in the
UPEI Panther Academy, and certify that he/she is physically fit to take part in all activities. Further, I do hereby
waive, release and forever discharge the University of Prince Edward Island, and its staff, from any and all claims of
damages occurring from accident, injury to person, or loss of personal property during program participation.
Registration forms may be dropped off at the Chi-Wan Young Sports Centre, UPEI or mailed to:
UPEI Panther Academy
Chi-Wan Young Sports Centre
University of Prince Edward Island
550 University Avenue, Charlottetown, PE C1A 4P3
PAYMENT
Forms with credit card payments can be faxed to 902-566-0700.
OFFICE USE ONLY
PROGRAM
RECEIPT #
PAYMENT METHOD
DATE PROCESSED
COST
NOVEMBER 8
GRADE 4-6
NOVEMBER 8
GRADE 7-9
NOVEMBER 22
GRADE 4-6
NOVEMBER 22
GRADE 7-9
NOVEMBER 8 & 22
GRADE 4-6
$15
NOVEMBER 8 & 22
GRADE 7-9
$25
$15
$15
$15
$25