Please print out this enrollment form and send it to Keith Buckley along with your payment.

Rollins College DISCOUNTS Keith Buckley 1000 Holt Ave., #2730 Winter Park, FL 32789-4499 One week Day Camp = $199 One Week Elite Camp $159 One Week Mini Camp = $135 Lunch (Per Week)      = $25

Rollins Dates Day/ Mini Camp May  29 -  June 1 June 4 - June 8 June 11 - June 15 June 18 - June 22 June 25 - June 29 Elite Camp June 11 - 15

<>Attending Weeks: Please Circle  Day Camp (inc Ball) 1    2    3 4  5 Lunch for Weeks: 1    2     3 4  5 Mini Camp 1    2     3   4   5 Ball for Mini Camp ($25) Elite Camp 1

 Name:  M  F___

 Parent/Gardian Name:_____________________________________Cell Phone ___________________

 Street Address:  Email :______________________________________

 City:  State:  Zip:_______________ Day Telephone: 

Evening phone: _________________ ______ In case of Emergency contact: 

Telephone:__________________________ Age:  D.O.B.:  Height:  School:  Grade:_________

 TeamName:____________________________________________________________
(10% discount for 10 or more players from the same team - to receive discount all the forms must be sent in one envelope)

 Total $  (Payable to Keith Buckley)
 Cancellation Policy - Five Days before the first day full refund. Within five Days full refund less a $50 administration fee. I hereby declare my son/daughter to be in good health and able to participate inthe camp activites. I will not hold the College or Camp Director responsible in case of injury as a result of participation. I will bear responsibilty for the full payment of tuition and fees.

Parent/Gardian Name:___________________________________Signature:  Date:

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