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APPLICATION FORM
Burlington Fitness & Racquet Club
Kids Summer Camp - 2017
Click for Details
PARTICIPANT
First Name
*
Last Name
*
Gender
M
F
Birth Date
+
HOUSEHOLD/ADULT Primary Contact
Relationship to Participant:
*
Self
Mother
Father
Guardian
Other
Other
First Name
*
Last Name
*
Address 1
*
Address 2
City
*
Province
*
Postal Code
*
Home/Cell Phone
*
Bus. Phone
Email Address
*
SELECT CAMP
SKILLS DEVELOPMENT PROGRAM
Full Day Camp - Hours are 8:30am to 4:00pm
$400 + HST = $452.00 BFRC MEMBERS
$450 + HST = $508.50 NON-MEMBERS
DATES for both camps (check)
*
July 31 - Aug 4
MINI-TENNIS TYKES CAMP
Half Day Camp - Hours are 8:30am to 11:30am
$250 + HST = $282.50 BFRC MEMBERS
$275 + HST = $310.75 NON-MEMBERS
PAYMENT METHOD
IMPORTANT
- Your credit card details are secure. We will process the payment after you submit the registration form.
If you have any questions please email Chris at bfrctennis@fitnessetc.ca
Card Type
*
Visa
Mastercard
Amex
Credit Card #
*
Expiry Date mm/yy
*
Security Code
*
AUTHORIZATION
*
I hereby authorize Fitness Etc. Inc. to charge my credit card for the amount selected above.
BILLING ADDRESS
Billing info is the same as above. If No, please enter your Billing Name/Address below.
*
Yes
No
First Name
Last Name
Street Address
Address Line 2
City
Province
Postal Code
Phone Number
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