Roth Report
Pete Dye River Course Cam
Television & Radio
Travel Center
2004 Hokie Football
Camp Application - July 11-14, 2004
(please print this form, fill it out, and mail it to the address below)
Name:________________________________________ Address:______________________________________ City:_____________________ State/Zip:___________
Home Phone Number (including area code):
_____________________________________________ School Now Attending:____________________________ Grade in Fall:___________________________________ Height:__________ Weight:__________ Age:_________ Parent/Guardian:________________________________ Roommate Preference:____________________________ Day Camper:_________ Overnight Camper:__________ Insurance Co.:__________________________________ Insurance Policy No.:_____________________________ Beyond its insurance coverage, I understand The Hokie Football
Camp is not responsible for more than the following insurance coverage:
$2,500 accidental death and dismemberment and $500 dental insurance.
________________________________________________________
Parent or Guardian Signature FULL PAYMENT DUE BY JUNE 18, 2004. NO EXCEPTIONS. NO APPLICATIONS
WILL BE ACCEPTED AFTER JUNE 18, 2004. Complete application and mail with $150.00 non-refundable deposit to: The Hokie Football Camp
c/o John Ballein
250 Jamerson Athletic Center
Virginia Tech Football Office (0502)
Blacksburg, Virginia 24061 (please make checks payable to: VT-FBC, Inc.) Adult Session
(please print this form, fill it out, and mail it to the address below)
Name:________________________________________ Address:______________________________________ City:_____________________ State/Zip:___________
Home Phone Number (including area code):
_____________________________________________ School Now Attending:____________________________ Grade in Fall:___________________________________ Height:__________ Weight:__________ Age:_________ Parent/Guardian:________________________________ Roommate Preference:____________________________ Day Camper:_________ Overnight Camper:__________ Insurance Co.:__________________________________ Insurance Policy No.:_____________________________ Beyond its insurance coverage, I understand The Hokie Football
Camp is not responsible for more than the following insurance coverage:
$2,500 accidental death and dismemberment and $500 dental insurance.
________________________________________________________
Parent or Guardian Signature FULL PAYMENT DUE BY JUNE 18, 2004. NO EXCEPTIONS. NO APPLICATIONS
WILL BE ACCEPTED AFTER JUNE 18, 2004. Complete application and mail with $150.00 non-refundable deposit to: The Hokie Football Camp
c/o John Ballein
250 Jamerson Athletic Center
Virginia Tech Football Office (0502)
Blacksburg, Virginia 24061 (please make checks payable to: VT-FBC, Inc.) Adult Session