BLUE CHIP MAIL-IN REGISTRATION FORM print  |  close window      Last Name:     First Name:     Street Address:     City:    State:    Zip:     Age (as of 7/09/12):    Grade (Fall 2012):       School You Will Attend in the Fall of 2012:     Home Phone:    Alternate Phone (Cell):     Emergency Contact (Name - Please PRINT):     Emergency Contact Phone Number:     Position(s) / Please Circle:       QB      Receiver/Back    Defensive Back      Line    Shirt Size / Please Circle:     S     M     L     XL    XXL    XXXL   Any Restrictions on Participation?       My son has permission to attend Blue Chip Camp. Enclosed is a $50 non-refundable reservation fee (or full payment of $170.00). This will be applied to the tuition, balance of which will be paid prior to camp. In the event of illness or injury I hereby give my consent for medical treatment and permission to the attending physician to hospitalize, secure proper treatment and order injections, anethesia or surgery. I will be responsible for any medical or other charges in connection with his attendance at camp.     CANCELLATIONS:  Written or emailed cancellations must be received no later than two weeks prior to the first day of camp (Deadline: June 25, 2012), in order to receive a refund. Refunds will be mailed in full less the $50 deposit/administrative fee.     PRINT Parent's Name:   Today's Date:       Parent's Signature:       Email Address:       He is Covered By (Name of Insurance Company):        Policy No.            Send Application (and make checks payable) to:   Blue Chip Camp, 33283 Harbor Reach Drive, Lewes, DE 19958