Address :
City :
State/Province :
Zip/Postal Code :
Country :
Phone Number :
Fax Number :
*Email :
Full Name of Parent:
Full Name of Camper:
Date of Birth (mm/dd/yy):
Gender:
Female
Male
If possible, I would like to room with:
If boarding locally with a relative or a friend:
T-Shirt size:
INTENSIVE WEEKLY CAMP:
(Sept - May)
Arrival (mm/dd/yy):
Departure (mm/dd/yy):
Please indicate: Boarding:
SUMMER CAMP 2008:
Summer Camp check-in starts on Sunday (between 2 p.m. and 5 p.m.) and ends on Saturday after lunch. Please check the session (s) you will be attending:
Session 1:
June 1- 7
Session 2:
June 8 - 14
Session 3:
June 15 - 21
Session 4:
June 22 - 28
Session 5:
June 29 - July 5
Session 6:
July 6 - 12
Session 7:
July 13 - 19
Session 8:
July 20 - 26
Session 9:
July 27 - August 2
Session 10:
August 3 - 9
Session 11:
August 10 - 16
Session 12
August 17 - 23
MEDICAL INFORMATION
Allergic to:
Vital Medication
Special instructions to camp physician and nurse, such as medications to be taken during camp:
I/We the parents authorize ITA to allow medical care for the above-named:
Yes
No
Family Physcian:
Physician Phone:
Authorized From (dd/mm/yy):
Authorized to (dd/mm/yy):
PAYMENT/CANCELATION
Pay by:
Card Number:
Expiration date (mm/yy):
Name on Card:
I authorize the following cahrges to my credit card:
Camp Deposit Fee ($500 per week)
Full Camp Fee
Credit Card Type:
AmEx
MC/Visa
Transportation Fee:
Total Charges:
CAMPER INFORMATION
Cell Phone of Camper:
Parent Cell Phone Number
Players Tennis Experience:
How did you find out about us?
