Child's Name:________________________________________
Parent's Name:_______________________________________
Address:_____________________________________________
City:_________________ State:______ Zip:_____________
Phone:____________________ Birthdate:________________
Child E-mail Address:________________________________
Parent E-mail Address:_______________________________
T-shirt Size (circle one) Child S M L Adult S M L
Credit Card #:_______________________________________
Type:_______________________________________
Exp. Date:_______________________________________
Please make checks payable to: Hokie Kids' Club
Return to: Hokie Kid's Club
Jamerson Athletic Center (0502)
Blacksburg, VA 24061
Call the Hokie Kids' Club Director
540-231-8783
Mon.-Fri. 9 AM - 5 PM
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