WHO:	Junior High Students
WHERE:	Poston Wrestling Room
WHAT:	Technique Training
WHEN:	_____ $40 12:30-2:15 Mon- Thurs. June 2 - June 19
CONTACT:	Ron Lans @ 472-2117
SIGN UP:	Complete the registration form and mail with check, money order or credit card information to the address at the bottom of the page or TO PAY ONLINE CLICK HERE: www.mpsaz.org/pay Then click on sports camps.

------------------------------Pay on-line or cut below and mail----------------------------

_____ $40

12:30-2:15

Mon- Thurs.

June 2 - June 19

Ron Lans @ 472-2117-- Account # 256-1308
TO PAY ONLINE CLICK HERE: www.mpsaz.org/pay
Then click on sports camps.
I give permission for my child to participate in the camp listed. I understand all risks and hazards
incidental to participation and do hereby waive, release, absolve, indemnify and hold harmless
Mesa Public Schools and the school from any claim arising out of any injury to my child.

Student Name:	.	(H) Phone:
Parent/ Guardian:	.	(W) Phone:

Address:

City:

Zip:

Amt. Paid : __________

Credit Card: ______Visa ______Mastercard __________________________________

Exp. Date:: __________

3 Digit Code: __________

Checks must be made payable to : Mesa Public Schools.
Mail to: Mesa Public Schools - Accounting CE, 63 East Main #101, Mesa, Az. 85201