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Summer Camp Registration

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*	First Name:

*	Last Name:

*	Email Address:

	Phone:

*	Program Interested In:

Summer Camps start in:

Summer Camps are here!

SUMMER CAMP REGISTRATION

Please complete a form for each camper. You will have an opportunity to pay once you submit this form.

General Information

Camper Name*

Gender*

Male
Female

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Age*

Date of Birth (mm/dd/yyyy)*

Grade Entering in Fall 2013*

Address*

Parent/Guardian Name(s)*

Phone #*

E-mail (parent's)*

This camper has food allergies.*

Yes *You must list allergies below.
No

Please list any food allergies this camper has. The Food Service Manager may call you for further clarification. Food allergies MUST be specified before arrival or we cannot guarantee accommodation.

Are there any physical limitations preventing full participation in the camp program?*

Physical limitations?

Yes *List limitations below.
No

Please list any physical limitations this camper has.

Program Selection

Please check each week that this camper will attend.

Adventure Camp (Boys & girls entering grades 1-3)

June 19-22 (Boys are FULL. Waiting List Available**)

Boy's Camp (For boys entering grades 3-11)

Boys Camp

Boys Week 1: Explorer (June 22-29)
Boys Week 2: Mystery (June 29-July 6)(Grades 9-11 FULL. Waiting List Available**)
Boys Week 3: Survivor (July 6-13)(Grades 6-11 FULL. Waiting List Available**)

Girls Camp (For girls entering grades 3-11)

Girls weeks

Girls Week 1: Explorer (July 13-20) (Grades 6-8 FULL. Waiting List Available**)
Girls Week 2: Mystery (July 20-27)(Grades 6-8 FULL. Waiting List Available**)
Girls Week 3: Survivor (July 27-August 3)(Grades 6-8 FULL. Waiting List Available**)

Wilderness Adventure Trips (Ages 14-18)

New River Gorge Experience (June 29-July 6)
Chesapeake Challenge (July 13-20)
Adirondack Adventure (July 27-August 3)

Optional (but helpful) Information

Church you attend

City

Bunk Request (only one)

I was referred by

I am a new camper

I would like information on

Camper Scholarships
Time Payments
Homeschool Family Camp
Classic Family Camp
Homeschool Classes (year round)

How did you hear about us?

Comments

Please register my child for the week(s) selected. I give permission for him/her to participate fully in all camp activities and to be included in any photographs and/or video productions. I understand that my $100 deposit is non-refundable, and that without a deposit, my child will not be fully registered, but placed on a waiting list.

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I agree*

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*Required

**To place your child on a waiting list for a week that's full: submit this registration form, but do NOT pay the deposit. We will contact you if space becomes available and you can pay at that time. Waiting lists are honored on a first-come, first-served basis.

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