form email test

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Email header pic

SELECT YOUR CAMP:

  • [programs]

SELECT YOUR T-SHIRT SIZE:

  • [shirt-size]

STUDENT INFORMATION

First Name

Last Name

Birth Date (MM/DD/YY)

Gender:

  • [gender]

Age

Grade (rising)

PARENT/GUARDIAN INFORMATION

First Name

Last Name

Primary Phone

Secondary Phone

Email Address

Summer Address

City

State

ZIP Code

Mailing Address

City

State

ZIP Code

EMERGENCY CONTACT INFORMATION

First Name

Last Name

Primary Phone

Secondary Phone

Relationship to Camper

REGISTRATION INFORMATION

Please mark which weeks your child will be attending.

Relationship to Camper

  • [weeks]

Rate:

Rising Stars:

1-3 Weeks

  • [Weeks-1-3]

4-7 Weeks

  • [Weeks-4-7]

8+ Weeks

  • [Weeks-7-8]

5 Star Tennis and Shooting Stars:

  • [star-5]

ADD-ONS & DISCOUNTS

  • [add-ons]

*Maximum of two discounts per camper

PAYMENT INFORMATION

Transportation

  • VISA

  • Mastercard

  • AMEX

  • Discover

Credit Card#

Expiration Date

Security Code

Billing Zip Code

Name on Card

Check

Cash

As parent or guardian of the applicant, I hereby accept the condition of enrollment and give permission for my child to perticipate inHampton Racquet programs. Iagree to comply with all progrom regulations, and hereby remove camp site staff and management at Hampton RacquetFrom any and all liabillity for injury or damagers insurred while involved in this program. Hampton Racquet retains the right toany photographsor videotapes of the campers taken at camp to be used for publicity or advertising.

Signature

Date

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