Please print this form, complete the information and send it to the address at the bottom of the page

(Check one): Resident___  Day (7th -12th grade)___  Day (4th - 6th grade)___

Name_____________________________________________________

(Circle one): M / F

Grade in 2008-09_______________

(Circle one): Varsity / JV / Modified / Elementary for Fall 2008

Position (circle one): outside hitter / middle blocker / rightside / setter

Years Experience____

Roommate Preference_______________________________________

School____________________________________________________

Returning Camper? Yes / No

Parents' Name______________________________________________

Address___________________________________________________

City________________________ State____________ Zip___________

Home Phone (_____) _____________ Work Phone (_____) ______________

T-Shirt size: S / M / L / XL

Please enclose a $50 non-refundable deposit with the application. Balance due and payable at registration or any time prior to registration. Make checks payable to Houghton College:

Mail to: Nancy Cole, Athletic Department, Houghton College, One Willard Avenue, Houghton, NY 14744

I understand that any camper who does not abide by the rules and regulations of the camp is subject to dismissal without reimbursement. I authorize the directors of the camp to act for me, according to their best judgment, in any emergency requiring medical attention. Any medical bills will be billed to the family's insurance plan primary carrier.

Signature of parent or guardian_____________________________________

Parent's health insurance company and policy number____________________________________________________________

If you have any questions, call Nancy Cole at 585-567-8837 or email at nancy.cole@houghton.edu.

FOR OFFICE USE ONLY: Deposit_____________ Date Received__________________ Balance Due_________________