Highland Park High School Hockey

Summer Program Application Form

 

 

Name:________________________________________________________

 

                 Address:_______________________________________________________________

 

              _______________________________________________________________

 

Player Phone Number (cell):_______________________________________________

 

Player email address:_____________________________________________________

 

Parents Name:___________________________________________________________

 

Home Phone:____________________________________________________________

 

Mother’s cell:_____________________       Father’s cell:_____________________­­___

 

Mother’s email:___________________       Father’s email:______________________

 

2007/2008 Team:___________________     Position:____________________________

 

Grade Next Year:_______________________

 

 

    Payment:

Check:     $350

Credit Card:   add 3% to cover bank’s credit card processing fee

 

 

If paying by credit card please fill out the attached form.

 

                                    Upon completion of the Application Form

                                    please fax to Stan Gardner at 214-528-3373

                                    or if paying by check please mail to:

                                                       Stan Gardner

                                                      4311 Potomac  Ave.

                                                      Dallas, Texas  75205

 

 

 

 

Highland Park High School Hockey

Credit Card Authorization Form

 

 

           Name:_____________________________________________________

 

 

Billing Address:______________________________________________________

 

  _______________________________________________ 

                                

Visa or Master Card: _________________________________________

 

Card Number: _______________________________________________

 

Expiration Date: ______________________________________________

 

 

Payment:  $360.50       ($350 plus 3% bank processing fee)

 

 

Signature: ___________________________________________________

 

 

 

 

Upon Completion of the Credit Card Authorization Form

please fax to Stan Gardner at 214-528-3373

or mail to:

Stan Gardner

4311 Potomac Ave.

Dallas, Texas 75205