Summer High School Program Registration

2024 Summer High School Players Program
Registration Form (3pm - 6pm)

Player's Name*

First Last

Age*

Please enter a number from 13 to 18.

Parent Information

Parent's Name*

First Last

Address*

Street Address City State ZIP Code

Parent's Email Address*

Enter Email Confirm Email

Home Phone*

Parents's Mobile Phone

Parent's Office Phone

Camp Options & Fees

3 Registration Options: 1) Multi-Week Discount Packages 2) Individual Weeks 3) Drop In Days

Multi-Week Discount Packages

Package Options

4 Weeks of High School Player Program $1,200
8 Weeks of High School Player Program $2,240
Nothing/Clear

Select Desired Weeks (4 or 8)

Additional weeks can be purchased at the discounted rate via emailing admin@passacademybullis.com.

Individual Weeks

Week 0n: June 10 - 14

High School Players Program (Wk0) $330
Nothing/Clear

Week 1n: June 17 - 21 (no 19th, 4 days)

High School Players Program (Wk1) $270
Nothing/Clear

Week 2n: June 24 - 28

High School Players Program (Wk2) $330
Nothing/Clear

Week 3n: July 1 - 5 (no 4th, 4 days)

High School Players Program (Wk3) $270
Nothing/Clear

Week 4n: July 8 - 12

High School Players Program (Wk4) $330
Nothing/Clear

Week 5n: July 15 - 19

High School Players Program (Wk5) $330
Nothing/Clear

Week 6n: July 22 - 26

High School Players Program (Wk6) $330
Nothing/Clear

Week 7n: July 29 - Aug 2

High School Players Program (Wk7) $330
Nothing/Clear

Week 8n: Aug 5 - 9

High School Players Program (Wk8) $330
Nothing/Clear

Week 9n: Aug 12 - 16

High School Players Program (Wk9) $330
Nothing/Clear

Drop In Days

Number of Drop In Days ($80 per day)

Price: $80.00

3pm-6pm

Drop In Date(s)

Enter the desired date(s).

Total Fees

$0.00

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Session

Summer: June 10th - August 16th 2024

Medical Authorization & Release

Camper Name*

First Last

Camper Condition*

By checking this box it is understood that the student is in overall good physical health. If your child has a physical condition that may limit or restrict participation in certain activities, a physician’s note granting permission to participate in such activities must be presented prior to the first camp session.

Date of Medical Authorization*

By dating above, in an emergency, when I/we cannot be contacted, I/we hereby authorize the staff of Pass Academy to take my/our child to the emergency room of the nearest hospital. I/we authorize that hospital and its medical staff to provide treatment deemed necessary for the well-being of my/our child.

Date of Parent Release*

By dating above, I agree to hold Pass Academy and Bullis School harmless for injury or loss that may occur as a result of my participation in Pass Academy activities.

Permission for Photo Use*

Yes
No

I give permission for photos of my child participating in Pass Academy at Bullis programs to be taken and used for the Pass Academy Website and/or Facebook page. We understand that if students are identified, only their first names will be used.

Additional Information (optional)

Summer High School Player Program Registration

2024 Summer High School Players ProgramRegistration Form (3pm - 6pm)

Parent Information

Camp Options & Fees

Medical Authorization & Release

2024 Summer High School Players Program
Registration Form (3pm - 6pm)