Basketball 101 Application

2006-2007 Basketball 101 Application 76ers Basketball 101 is a fast-paced clinic designed to teach the fundamentals of basketball. Basketball 101 is available for after school programs, gym classes, and recreational leagues targeting kids 6-14 years old. The 76ers professors of basketball, take kids through a "class" in basketball. The clinic consists of “the professor” leading the kids in stretching, fundamentals and fun games including dribbling races. The games’ focus on practicing basic basketball skills. Upon completion of the program, "graduates" are awarded diplomas. Please complete the following application to request the 76ers Basketball 101 for your school, after-school program, or special event. Location of interest must be within the Delaware Valley (Southeastern Pennsylvania, South Jersey, and Delaware) and provide access to basketball court. If you are interested in having the 76ers Basketball 101 program attend your school or after-school program please fill out the following application and fax it to: 76ers Marketing at 215-339-7615. Please include with your application a copy of insurance for your site. Name of Program/School:_____________________________________________________________ Address: _____________________________________________________________________________ City: ________________________________ State _________ Zip Code _____________________ Contact Person: ______________________________________________________________________ Daytime Phone Number: ________________Evening Phone Number:_____________________ Email Address: _______________________________________________________________________ What is your relationship with the program/school?_____________________________________ How many kids will you expect? ______________________________________________________ If you are inquiring about a certain date and time, please state: ______________________________________________________________________________________ ______________________________________________________________________________________ If you do not have a specific date, please state which days of the week and/or times are best for the clinic: ______________________________________________________________________________________ ______________________________________________________________________________________ Is there a basketball court indoors to use for the clinic? Yes No Microphone? Yes No Any basketball programs, if any, are used at the site? ______________________________________________________________________________________ ______________________________________________________________________________________ Have you had a 76ers community program at your school in the past? Yes No | If so, for what? ______________________________________________________________________________________ ______________________________________________________________________________________ Can you provide a certificate of insurance for the site? Yes No How did you hear about the 76ers Basketball 101 program? ______________________________________________________________________________________ ______________________________________________________________________________________ Why should this site be considered for the Basketball 101 program? ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ Applicant Name _________________________________________________________ Applicant Signature _______________________________ Date __________________