Ultimate VBC 2009 Summer Camps Registration Form

Make checks payable to Hallmark Sports Club and return registration form and fee to Hallmark Sports Club II, 8328 Colorado Street, Merrillville, IN 46410

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PLEASE FILL OUT THIS FORM IN ITS ENTIRETY

Name:__________________________________________________________________

E-Mail: _______________________________________________________________

Address(City/State/Zip):____________________________________________________

Position: ______________________________________

Phone #: ______________________________________

Emergency Phone #:____________________________________

D.O.B. (YYYY-MM-DD): __________________________

CampName(s):___________________________________________________________

Session Number(s): ________________ Entering Grade: ___________

TO PAY BY VISA OR MASTERCARD:

Name as Appears on Card: ________________________________________________________________________

Type of card (Circle one): Visa MasterCard

Credit Card #:

Expiration Date: ___________________________________________

Signature of Cardholder: ________________________________________________________________________

Total Amount Charged: ____________________________

Waiver: I acknowledge that there are certain risks of injury to participants, and I agree to assume full risk of any injuries, damages, or loss which I or my child/ward may sustain as a result of participating in any activities connected with such programs.

Parent Signature:__________________________________________________________

Date__________________________________________________