Bears Basketball Registration Form

You may fill out this secure online form (read security info) and submit it here; you may print it, fill it out, and mail it to the address at the bottom of the form; or you may fax it to: the Center for Lifelong Education and Recreation (CLEAR), (315) 267-3350.

This form uses an automatic totaling script. If you have difficulty reading or submitting this form, the reason may be that your browser does not support forms or scripts. If you have questions or would like to request a paper copy of the registration form, you may call (315) 267-2167 or e-mail camps@potsdam.edu.

A non-refundable deposit of $50 (U.S. funds) is required to reserve your spot in the camp. Complete the form below by July 8th.

Camper's name:

Parent's name:

Street:      City:      State:      Zip: 

Home Phone:

Work Phone:

Cell Phone:

E-mail:

Date of Birth:

Gender:
    Male
    Female

Grade (fall 2013):

School:

T-shirt size:





Camper Type:
    Resident
    Commuter

Roommate request:


(one name only, campers must request each other, honored when possible)

How did you learn about camp?

Payment Information


Please charge my credit card only the non-refundable $50 deposit at this time.

$

Please charge my credit card the full payment now.

$

Please charge my credit card only this amount at this time:


$


Center for Lifelong Education and Recreation
389 Van Housen Ext., SUNY Potsdam
44 Pierrepont Ave., Potsdam, New York 13676
phone: (315) 267-2167 fax: (315) 267-3350
e-mail: camps@potsdam.edu

Have a question or comment?

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Read the Center for Lifelong Education and Recreation refund policy.