UNITED STATES SPORTS CAMPS
2008
Registration Form (Please Print in Black Ink)
Name ______________________________ Birth date _________ Age At Camp_______ Gender: □ Male □ Female
State ____ Zip Code
_________Phone (_____)__________________Email
Address____________________________
Name of Your Coach (_____)_________________________________________________________________________
Your Coach’s Address (Street)
State _____ Zip Code
_________Phone
________________________Email Address___________________________
Name of Roommate Desired _____________________________________________________ Check if Commuter □
Referred by ______________________________________________________________________________________
WE RECOMMEND THAT YOU
KEEP A COPY OF THIS APPLICATION FOR LATER REFERENCE.
CAMP LOCATION REQUEST
PLEASE CHECK YOUR CHOICE (s)
CAMP LOCATION 2008
Date 2008
Fee Deposit
w/ Balance
due
(Check weeks)
application by 6/1/08
Mount Holyoke College
□ South Hadley, Mass June 29-July 4 $750.00 $200.00 $550.00
□ Weekend
stayover* July
4-6 $250.00 Payable with balance
□
□
Weekend stayover* July 11-13 $250.00 Payable with balance
□
□ Weekend
stayover* July
18-20 $250.00 Payable with balance
□
*Weekend stay over is only available with two week registration.
|
If paying by check, please make checks payable to: U.
S. Sports Camps, Ltd. or (U.S.S.C.) Circle Your Credit Card: MC VISA Amount charged on card - please
check: ❏ deposit ❏ balance on 6/1/08 ❏ entire amount upon receipt of
application Credit Card
Number____________________________________
Card Expiration Date____________ Name On
Card_________________________________________ mail payment/completed application
to: U. S. Sports Camps, Ltd. • P.O. Box 428 • |
U. S. Sports Camps has my permission to have ______________________________________________ (Name of Applicant)
treated professionally in an emergency. Parent/Guardian Signature
______________________________________________
Parents/Guardians:
We need original signatures on all applications - no faxes, copies or emails
Campers
must have their own health insurance.
Name of
Insurance Carrier
(MUST
BE FILLED OUT) ________________________________________________________
Policy Number _________________________________________________________________(No insurance, No camp)
All deposits of accepted applications are non-refundalbe. All cancellations after
June 1, 2008 are non-refundable.
USSC accepts MasterCard, Visa,
credit cards for deposits and balance of payment.