Sportstar Academy - Online Form

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Online Application for 2010

Please submit this application with a deposit of $100 in order for your application to be processed. If we receive a cancellation by January 1st, then the deposit will be refunded. After January 1st, fees are non-refundable. No allowance will be made for late arrivals, early departures or late cancellations. Camp fees include laundry service, and transportation from the NYC Metropolitan area. Pay online here.
Camper Information
Name * First Last
Gender * Male Female
Social Security #
Phone * - (###) - ### ####
Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Camper Email *
Date of Birth * / MM / DD YYYY
Grade Entering Sep 2010 *
Camp attended last year *
School Information/Reference
School Enrolled: *
School Phone * - (###) - ### ####
Teacher Refrence First Last
Parent Information
Salutation *
Mothers name * First Last
Day Phone * - (###) - ### ####
Night Phone * - (###) - ### ####
Cell Phone * - (###) - ### ####
Mothers Email *
Fathers Name First Last
Day Phone - (###) - ### ####
Night Phone - (###) - ### ####
Cell Phone - (###) - ### ####
Fathers Email
How did you find us?
Medical Information
Dr. Name * First Last
Phone # * - (###) - ### ####
Sport/Activity - First Choice
Sport/Activity - Second Choice
Sport/Activity - Third Choice
Sport/Activity - Fourth Choice
Please list bunk requests (up to 3)and add any comments here.