Individual Application Form 2010(for individual print-out and mail-in only, not to be used for duplication)
Competitor's Edge at Fairleigh Dickinson University, Madison, NJ
PLEASE COMPLETE, PRINTOUT, SIGN, AND MAIL IN WITH DEPOSIT.

Name (Last, First) Commuter Resident
Address City State Zip
Parent's Name &
Home Phone ( ) Emergency Phone ( )
Parent/Your E-mail Address
Birth Date Age At Camp Reversible size - M / L L / XL
Roommate Request (one person only - must be mutual)
Position you play or wish to play Please click on arrow to select a position
Your School Year/Grade Going Into in Sept. 2010
Coach's Name Coach's Phone Number ( )
Coach's E-Mail Address
Please Select A Session:

PLEASE DOUBLE CHECK YOUR WORK THEN GO TO FILE AND PRINT NOW

Please read and sign
I hereby authorize the Director of Competitor's Edge Field Hockey Camp to act for me according to their best judgement in any emergency medical attention. Enclosed find a check of $175.00 as a deposit to reserve a space for my daughter. I understand this reservation deposit is non-refundable after July 1, 2010. I understand that a $40.00 processing fee is non-refundable under any circumstance. There is an insufficient funds fee of $50.00. Full payment must be received by June 1, 2010. If applying after May 15, 2010, please submit payment in full. Application deadline is July 6, 2010. If you have not received Confirmation within one month of mailing application, please email us at Stickscamp@aol.com or call the camp phone 973-443-8045.

Signature of Parent__________________________________________________________________

Make check payable to: COMPETITOR'S EDGE
Mail to:   Competitor's Edge Field Hockey Camps
Processing Center
P.O. Box 170
Convent Station, NJ 07961-0170
IMPORTANT:  If you send Express Mail or Priority Mail requesting a receipt you must WAIVE THE SIGNATURE. Receipts are date and time stamped when the mail is placed in the box. Failure to waive the signature may cause return to sender by P.O. No certified mail.

Email us at Stickscamp@aol.com Phone: 973-443-8045 Fairleigh Dickinson University is not liable for any of the activities in respect to the camp. The Camp Director is an independent contractor.
OFFICIAL USE ONLY: Ck.# ___________________________ Amt. _____________________ Date _____________________

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