Volleyball Express Camp - Registration Blank

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

Please check week preferred:

___	June 20-23, 2010
___	July 18-21, 2010
___	July 25-28, 2010

Make sure to include your completed Medical Statement and Release form.
Download the Medical Release Form here

Resident: $415 (Room, Board, and Instruction)
Commuter: $280 (Instruction only)

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

*** You must print and fill out the medical release and send it with your registration.
Download the Medical Release Form here

volleyballexpress@comcast.net