Please provide the following registration information:

Name
Address
City
State
Zip
Title, Coaching Position, or Sport Position
Organization, High School, or College
Age
Grade
Past Injuries
Medical Conditions
Have you had a physical?	Yes No
Allergies
Work Phone
Home Phone
Primary Sport	Football Basketball Soccer Field Hockey Track and Field Softball Baseball Hockey Volleyball Lacrosse
Secondary Sport	Football Basketball Soccer Field Hockey Track and Field Softball Baseball Hockey Volleyball Lacrosse
Other information or individual training requests
Sport interested in developing speed for:	Football Basketball Soccer Field Hockey Track and Field Softball Baseball Hockey Volleyball Lacrosse
E-mail
Preferred Location (please check)	Northern NJ- Saddle Brook HS, Saddle Brook, NJ (Base Location)  : 8 week camp, 4 week camp, and 2 week camp offered
Choose the Camp and The Dates You Will Be Attending:	DATES:  8 week camp (24 Sessions): June 21- August 13th  4 week camp (12 Sessions): Session 1- June 21-July 16st Session 2- July 19st- August 13th 2 week camp (6 Sessions): Session 1- June 21-July 2th Session 2- July 5th - July 16th Session 3- July 19th - July 30th Session 4- August 2-August 13th
Time Slots Available (please choose your preference) Choose two slots	9am-10:30am 10:30am-12pm 5:00pm-6:30pm 6:30pm-8pm

Please provide choose the camp that best suits you:

# of Athletes	Amount	Camp
	$223.99 per person
	$149.99 per person
	$119.99 per person
Payment Information
In order to secure your spot you must pay the $60 deposit. (spots are filling up fast). We can charge you for the deposit if you pay by credit card and we will not charge the full amount till the week before the camp starts or you can pay for the camp in full. If you want to pay by check please send check to: Schuman's Speed Center, 49 Finnigan Ave. Q-3, Saddle Brook, NJ 07663
Type:	Visa Mastercard	Credit Card #
Name On Card
Address
Expiration Date	Month: January February March April May June July August September October November December Year: 2003 2004 2005 2006 2007 2008 2009 2010
Pay Full Amount	Pay Deposit Now

Please fill out the form and we will contact you to set you up with the appropriate camp for your sport. If you want individualized person speed training please indicate and we will arrange that for you as well. You can fill out this form and mail your check for the appropriate amount to: Schuman's Speed Center, 49 Finnigan Ave. Suite Q-3, Saddle Brook, NJ 07663. Remember for the 8 week camp it is $223.99 ,for the 4 week camp it is $149.99, and for the 2 week camp it is $119.99.

The $60 deposit is non refundable and assures you a place in our camp

Questions? Call us at 1-866-Schuman or email us at schumanspeed@aol.com