Mail-in/Fax-in Application
    Print, fill out, and mail or fax this form as an alternative to using our online signup form.
Full Name  
Street Address  
Address
Line 2		  
City  
State/Province  
Zip/Postal Code  
Email address  

 

 

Select Location & Camp Session

  
             dates        resident   commuter  
21-DAY INSTITUTE
Boston, MA    06/29 - 07/19   $1825   $1400  
12-DAY CAMP
Boston, MA    06/29 - 07/10   $975   $700  
Boston, MA    07/13 - 07/24   $975   $700  
7-DAY CAMP
Boston, MA    06/29 - 07/05   $625   $470  
Boston, MA    07/13 - 07/19   $625   $470  
5-DAY CAMP
Boston, MA    07/13 - 07/17   $465   $350  
Desired Format   Primary Intensive
Age   years
Current Weight   lbs
Years Involved in
Organized Program		   years
Grade Entering
Next Year		   (enter "G" if graduating)
T-Shirt Size   (M-L-XL-XXL)
SAT Prep?   Yes No
Transportation
Credit? 		  Yes No
Family Discount?   Yes No
Team Discount?   Yes No
    If you answered yes to 'Team Discount,' enter your program information below.
Coaches Name  
School Name  
   
Section Below to Be Completed By Applicant's Parent or Legal Guardian
Home Phone  
Emergency Number
Other Than Home 		 
Health Insurance Co.  
     
   

To complete this application, a parent or guardian must pay a non-refundable deposit and authorize medical treatment.

The 24-Day Camp requires a $250 deposit; the 12-day sessions require a $150 deposit; the 5 and 7-day sessions require a $100 deposit.

Fill in your credit card information below or mail this application with a check or money order payable to "Asics Institute."
Name on Credit Card  
Card Number  
Credit Card Type   Visa MasterCard Discover
Expires  
     
Parent or Legal Guardian's Signature  

"In case of injury or illness, I authorize treatment."

Mail or fax this form to the institute at:

Carl Adams
300 Babcock Street
Boston, MA 02215

FAX: (617) 353-5286