Huntersville Family Fitness & Aquatics


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Huntersville Family Fitness & Aquatics requires the following information and your authorization to charge your credit, debit or checking account for the weeks your child(ren) are attending our program. Child(ren)'s Name: _________________________________________________________________________________ Name as it appears on the card: ____________________________________________________________________ Credit Card Type: q Visa q MasterCard Credit Card # ____________________________________________________________ Name as it appears on Checking Account: ____________________________________________________________ Routing # ________________________________________ Bank Account # __________________________________ Charge Authorization Form By signing below, I hereby authorize HFFA to charge the above listed credit card or checking account for the non- refundable registration fee, non- refundable 10% deposit and the weeks indicated above for my child(ren) to attend camp. I understand this information is confdential and will be kept as a part of my records. I will notify HFFA if I change fnancial institutions or credit card numbers so that my payment is not delayed. Signature:_______________________________________________________________________ Date:________/________/20______ Total of the weeks selected $ __________ 10% of the total weeks $ __________ * Registration fee $ __________ Total due at registration $ __________ Date q June 27 - June 30 $____________ q July 4 - July 7 $____________ Enter the rate as it applies to your camper by each week that you wish to enroll your camper. Empower Sports Empower Sports Tuition: Member - $99.00 Non-Member - $109.00 No additional child discount offered. If you have selected Member Pricing enter your Key Tag # here_____________ 2016 SIZZLIN' SUMMER CAMPS R8

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