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Volleyball Express Registration Blank
| Fill Out and Mail to: |
Please check |
| Volleyball Express |
week preferred |
| c/o Lori Rose |
__ June 23 - June 27, 2002 (girls) |
| 1384 Megan Drive |
__ June 23 - June 27, 2002 (boys) |
| State College, PA 16803 |
__ July 21 - July 25, 2002 |
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__ July 28 - Aug. 1, 2002 |
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| Name_________________________________________________________________________________ |
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| Address_______________________________________________________________________________ |
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| City_________________________ |
State________________________ |
Zip__________________________ |
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| Phone Number________________ |
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| Circle Grade Entering in Fall '02 |
8 9
10 11 12 |
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| Name of School_________________________________________________________________________ |
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| U.S.V.B.A Club Team (if
any)_______________________________________________________________ |
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| Roommate Preferred (if
any)________________________________________________________________ |
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(Two campers per room - one name only please) |
| I hereby authorize the directors of the Volleyball
Express Camp to act for me according to their best judgment in any
emergency requiring medical attention. My own medical coverage
will be the primary coverage; camp insurance is the secondary coverage |
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| Signature of parent or guardian
______________________________________________________________ |
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| Medical
Insurance*_______________________________________________________________________ |
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| Policy
Number__________________________________________________________________________ |
| *Insurance must be provided by the camper |
| ADVANCE REGISTRATION AND PAYMENT IN
FULL IS REQUIRED TO ASSURE PLACEMENT |
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| Make checks payable to Volleyball Express, Inc |
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