Camp Application

 

First Name				Last Name
Address
City				State			Zip
Sex	Birthdate					Age as of 6/1
School					Grade
Home Phone			Email
Mother Name		Work Phone					Cell
Father Name		Work Phone					Cell

 

 

 

 

 

 

 

 

 

 

 

 

 

 T-Shirt Size:                 Junior ___S      ___M   ___L                Adult    ___S    ___M   ___L    ___XL

Level:

Tennis ______________                     Basketball______________                Swim ___________

Soccer ______________                    Lacrosse   ______________  

 

Check Desired sessions         6/27     7/4       7/11    7/18      7/25      8/1       8/8      8/19

                                                Wk 1   Wk 2    Wk 3   Wk 4   Wk 5   Wk 6   Wk 7   Wk 8

1.       Basketball Camp                 ____    ____    ____    ____    ____    ____    ____   ____  

2.       Soccer Camp                                              ____    ____    ____    ____    ____    ____  

3.       Lacrosse Camp                                           ____    ____    ____    ____    ____    ____

4.       Tennis Camp                       ____    ____    ____    ____    ____    ____    ____    ____  

5.       Multi Sports Camp               ____    ____    ____    ____    ____    ____    ____    ____

6.       Camp Old Westbury            ___________   __________   __________    __________

7.       Circus Arts Camp               ___________   __________   __________    __________

8.       Swim Camp                        ____    ____     ____    ____   ____    ____    ____    ____

 

Price:                $420 per week             $840 per two week session     

Discounts:         Sibling $25/wk Early enrollment (not valid after 2/12) $40/wk

 

Transportation ($125/week):     ___ Y  ___N                           Lunch ($45/week):       ___Y   ___N

 

Enclosed is my deposit of $200 per week         # of Weeks ____ x $200 Totaling $_____

Please charge my credit card      €Mastercard   €Visa

Name _____________________________________

Card no. ___________________________________            Exp date __/__/__

 

Please Make Checks payable to:            OW Sports Associates

                                                            546 Bedford Road

                                                            Armonk, NY 10504       fax 914-273-8506

 

As parent or guardian of the applicant, I hereby accept the condition of enrollment and give permission for my child to participate in the Future Stars Program. I agree to comply with all program regulations, and hereby remove campsite, staff, management, Future Stars Tennis LLC, and SUNY College at Old Westbury from any and all liability for injury or damages incurred while involved in this program. Future Stars Tennis LLC retains the rights to any photographs or video tapes of the campers taken at camp to be used for publicity or advertising.

I understand the balance will be charged April 1st, 2005

 

Signature ______________________________________________            Date _____________