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Registration Specialty Camps Shooting Camp (Boys & Girls)
Registration Specialty Camps Shooting Camp (Boys & Girls)
"Blue-Chip" Specialty Camps |
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| 2010 "Blue-Chip" Shooting Basketball Camp Application Fee $185.00 (please print or type) |
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| Player’s Name | ____________________________________________________________ |
| Home Address | ____________________________________________________________ |
| City _________________________ State _____ Zip ________ Phone (_____) _______________ | |
| Height _______'_______" Age ______ Next Year Grade (2010-2011) ___________ | |
| Roommate Preference | _______________________________________________ |
| Please indicate your payment plan: ____ $100 Deposit – Check enclosed ____ $185 (Total Tuition) – Check enclosed ____ Mastercard ____ Visa ____ American Express ____ Discover Amount to be billed $__________ Card No.________________________________________ Exp. Date___________ Note: Deposit is non-refundable. For questions: call (502) 543-7308; fax (502) 543-4635; e-mail bolus@insightbb.com RELEASE & WAVIER: The "Blue-Chip" Shooting Camp does not provide medical insurance for campers. This is the responsibility of the parent or guardian. Your signature below gives permission for treatment for injury or illness at the Georgetown Community Hospital with the understanding that the financial responsibility is yours. Final payment is due two weeks before camp starts. |
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| Parent Signature________________________________________________________Date____________ | |
Post Camp |
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