home philosophy staff location and facility special features advance registration registration blank e-mail notification

FILL OUT AND MAIL TO:
Volleyball Express Camp
1384 Megan Drive
State College PA16803

Please check week preferred:
___ June 22-25, 2008
___ July 13-16, 2008
___ July 20-23, 2008

Name _________________________________________________
Address _______________________________________________
City _______________________ State _________ Zip _________
Date of Birth ______________ Phone _______________________
E-mail Address _________________________________________
Circle Grade Entering in Fall '08: 8 9 10 11 12
Name of School _________________________________________
U.S.V.B.A. Club Team (if any) ______________________________
Roommate Preferred (if any) _______________________________

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 prime coverage; camp insurance is the secondary coverage.

Signature of parent or guardian ____________________________________________
Medical Insurance*______________________________________
Policy Number _________________________________________
*Insurance must be provided by the camper.

ADVANCE REGISTRATION AND PAYMENT IN FULL IS REQUIRED TO ASSURE PLACEMENT.

Lost Room Key – $50.00 charge. By signing this registration you have agreed to pay $50.00 if the camper named above loses her key.

Make checks payable to: Volleyball Express, Inc.
For Additional Information Contact:
Lori Rose
(814) 238-SET4 (814) 238-7384
E-mail: volleyballexpress@comcast.net
volleyballexpress@comcast.net