The Arlen Specter US Squash Center Summer Camp Registration Form
Thank you for taking part in activities at the Specter Center - the world's largest community squash center and home of US Squash!
Participant's Full Name
*
First Name
Last Name
Participant's Date of Birth
*
-
Month
-
Day
Year
Date
Participant's Gender
*
Male
Female
Non-Binary
Prefer not to say
Participant's Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Participant's School
*
Are there any medical conditions we should know about?
*
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Email
*
example@example.com
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Parent/Guardian 2 Name
First Name
Last Name
Parent/Guardian 2 Email
example@example.com
Parent/Guardian 2 Phone Number
Please enter a valid phone number.
Emergency Contact: Full Name + Phone Number
*
Do you know your US Squash Club Locker account number? (if you do not have an account please visit spectercenter.org/member login to create one.)
Please select the session you are registering for:
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August 29- September 1 (10:00am-4:00pm) Squash and Pre-Season Fitness
Are you interested in receiving financial assistance on Specter Center Summer Camp?
*
Please Select
Yes
No
If you are interested in receiving assistance, please submit the following information:(1.)Most recent year’s 1040 Federal Tax Return (2.)Two most recent pay stubs for all adults in the household If you are unable to provide the required documentation please email membership@spectercenter.org
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Are you interested in purchasing a Specter Center Membership?
*
Yes
No
Maybe
Already have one!
A non-refundable deposit will be required for each selected camp week. You will automatically be charged $100 once the application is submitted, followed by a one-time charge for the deposit on remaining weeks.
*
Please Select
I agree
I disagree
If you are unable to attend a camp week you must inform karim.ibrahim@spectercenter.org within 48 hours or more of the start date in order to receive a refund less the deposit. If you cancel within 24 hours of the start date, you are not entitled to a refund.
*
Please Select
I agree
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Summer Camp Deposit
A non-refundable deposit is required to hold each selected camp week. This deposit will be applied to the camp week.
$
100.00
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
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