Summer Sports Camps 2009 Registration Form - PDF

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Summer Sports Camps 2009 Registration Form - PDF Powered By Docstoc
					                                     Summer Sports Camps 2009 Registration Form
                               Print this form. Mail the signed, completed form with full payment to:
                                      BucksMont Indoor Sports Center. Hatfield, P.A. 19440

Camper Information

Last Name:                                                                   First Name:

Street:

City/State/Zip:

Date of Birth:                                                               Age:


                                                                             Phone #:
Sex:                       Male        Female

                                   Mark your SELECTION(S) for the desired sport(s) and dates!


       Youth Volleyball Summer Camp                            June 22nd-                                Non-
                                                                                    Member       $215            $240
                                                               June26th                                 Member

Chuck Rocconi Football Summer Camp                             June 29nd-                                Non-
                                                                                    Member       $225            $250
                                                                July3rd                                 Member

          Youth Soccer Summer Camp                        July 6th-July 10th
                                                                                                         Non-
                                                                                    Member       $205            $230
                                                                                                        Member

    FSC Field Hockey Summer Camp                         July 13th-July16th
                                                                                                         Non-
                                                                                    Member       $245            $275
                                                                                                        Member

FSC Skills Field Hockey Summer Camp                         July 20th-July                               Non-
                                                                24th
                                                                                    Member       $150            $180
                                                                                                        Member

 High School Volleyball Summer Camp                            July 20th-
                                                                                    Member       $215
                                                                                                         Non-
                                                                                                                 $240
                                                                July24th                                Member

           Lacrosse Summer Camp                                August 3rd-                               Non-
                                                                                    Member       $150            $180
                                                               August 7th                               Member

                                                   Please Select Payment Method
                                      Cash or Check payable to BucksMont Indoor Sports Center
                                            Please write Camper's Name on top of check.

Credit Card Name:                               Card Number:                                                Expiration Date

                                                                                                            _____/_____/_____

Cardholder's Name:                              Cardholder's Signature                                      Charge Amount

                                                                                                            $_____________



Print Name:                                                                          Date:


Signature of Parent or Guardian:                                                     E-mail Address:



                  Questions? Email us at info@bucksmontisc.com or give us a call at (215)-996-1740