Can-am Race Camps 2009-2010 Registration Form
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CAN-AM RACE CAMPS CAMP REGISTRATION FORM/RECEIPT PLEASE PRINT CLEARLY
Participant Name
Date of Birth
Age on 05/01/09
Sex Grade
Team or School
USSA #
Participant Name
Date of Birth
Age on 05/01/09
Sex Grade
Team or School
USSA #
Participant Name
Date of Birth
Age on 05/01/09
Sex Grade
Team or School
USSA #
Primary Email:________________________________ Address (where you want to receive can-am communications): CITY,ST
ZIP
Father’s Name: ________________________________________ Email:_______________________________________ Phone: (h) ____________________________ (w) ________________________(cell) ______________________ Father’s Mailing Address: ______________________________________ City: ________________________ State: ______ ZIP: ______________ Mother’s Name: ________________________________________ Email:_______________________________________ Phone: (h) ____________________________ (w) ________________________(cell) ______________________ Mother’s Mailing Address: ______________________________________ City: ________________________ State: ______ ZIP: ______________ Emergency Contact Name: _________________________________________ Emergency Contact Phone: ________________________________________ PROGRAM REGISTATION & FEES SESSION NAME OF PARTICIPANT
CAMP FEES
BALANCE DUE
DEPOSIT
(circle any that apply)
EARLY CAMP
WEEK CAMP
[1 2 3 4][ 5 6 7 8 9 10]
$750
$1,970
$500
[1 2 3 4][ 5 6 7 8 9 10]
$750
$1,970
$500
[1 2 3 4][ 5 6 7 8 9 10]
$750
$1,970
$500
(IMPORTANT) Name and mailing address of financially responsible party: TOTAL
Mail forms to: Can-Am Race Camps, PO Box 833, Lake Oswego, OR 97034
OFFICE USE ONLY □ Liability Release □ Medical Form □ Discipline Contract □ Payment Contract (if applicable) □ Camp Outline □ Mt. Release
Make checks payable to Can-Am Race Camps
notes:
CAN-AM RACE CAMPS CAMP REGISTRATION FORM/RECEIPT PLEASE PRINT CLEARLY
Participant Name
Date of Birth
Age on 05/01/09
Sex Grade
Team or School
USSA #
Participant Name
Date of Birth
Age on 05/01/09
Sex Grade
Team or School
USSA #
Participant Name
Date of Birth
Age on 05/01/09
Sex Grade
Team or School
USSA #
Primary Email:________________________________ Address (where you want to receive can-am communications): CITY,ST
ZIP
Father’s Name: ________________________________________ Email:_______________________________________ Phone: (h) ____________________________ (w) ________________________(cell) ______________________ Father’s Mailing Address: ______________________________________ City: ________________________ State: ______ ZIP: ______________ Mother’s Name: ________________________________________ Email:_______________________________________ Phone: (h) ____________________________ (w) ________________________(cell) ______________________ Mother’s Mailing Address: ______________________________________ City: ________________________ State: ______ ZIP: ______________ Emergency Contact Name: _________________________________________ Emergency Contact Phone: ________________________________________ PROGRAM REGISTATION & FEES SESSION NAME OF PARTICIPANT
CAMP FEES
BALANCE DUE
DEPOSIT
(circle any that apply)
EARLY CAMP
WEEK CAMP
[1 2 3 4][ 5 6 7 8 9 10]
$750
$1,970
$500
[1 2 3 4][ 5 6 7 8 9 10]
$750
$1,970
$500
[1 2 3 4][ 5 6 7 8 9 10]
$750
$1,970
$500
(IMPORTANT) Name and mailing address of financially responsible party: TOTAL
Mail forms to: Can-Am Race Camps, PO Box 833, Lake Oswego, OR 97034
OFFICE USE ONLY □ Liability Release □ Medical Form □ Discipline Contract □ Payment Contract (if applicable) □ Camp Outline □ Mt. Release
Make checks payable to Can-Am Race Camps
notes:
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