Blue Chip Camp Reg & Payment

Blue Chip Middle School Prep Camp

Saturdays; March 7th, 14th, 21st, 28th @ 2pm; @ the LI Indoor Sports Field: 101 Union Ave Ronkonkoma
Player Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
BEST Email*
example@example.com
BEST Phone Number*

Area CodePhone Number
Date of Birth*
HS Graduation Year*
Position(s)*
Parent/Guardian Name(s)*
Notes (if necessary)
Amount you authorize Blue Chips to Charge*
There is a 3% service charge that will be added to this amount
Signature*

Clear
3% service charge
Total

Amount to Charge*

USDFees are non-refundable

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Please check off*

I agree to have Blue Chip Prospects charge my credit card. I understand that fees are non-refundable. I do hereby release, discharge, indemnify and hold harmless Blue Chip Prospects, and its owners, directors, officers, employees, agents, successors, and assigns from and against, and waive any and all claims or liabilities for, any injuries, losses or damages, including without limitations, injuries to my child, my self and/or property, arising out of or incident to my child’s participations in the Blue Chip Prospect event.
Should be Empty:

Blue Chip Middle School Prep Camp