Child's First Name:       

Child's Last Name:        Age:   

Parent or Guardian First Name:   

Parent or Guardian Last Name:   

Home Address:   

City:     State:     Zip Code:

Home Phone:     Day/Work Phone:        Fax Number: 

Parent or Guardian E-Mail Address:

Choose Camp Dates to Attend:  June 23rd thru June 27th July 14th thru July 18th August 4th thru August 8th

Method of Payment: Credit Card Check Cash   

Before/After Care:  Yes No   (Additional $25.00 cost)

Medical Insurance Provider:

Medical Insurance Number:    

PAYMENT FOR CAMP IS DUE TWO WEEKS PRIOR TO CAMP BEGINNING.

If paying by credit card, please visit us at the address below; so we may process  your credit card electronically.    

If paying by check or money order, please remit to :

Next Level Hitting Instruction

2700 East Olivera Road

Concord, CA  94519

Comments or Questions: