`June 13th-19th, 2010 Summer Camp Registration`

PLEASE register ALL adults and children who will be attending (submit multiple registration forms if necessary)

Name:
Address:
City:
State:
Zip Code:
Phone:
E-mail:
Full time camper
Part time camper (don't foget to fill in part time info below if you clicked this)

Accommodations:

Age Group (see below for children under 18): 18-29 30-35 36-50 51-65 over 65

Roommate Preference:

________________________________________________________

Children under 18:

Child 1

Name: Age:

Email Address (optional):

Phone Number (optional):

Accommodations:

Roommate Preference:

Child 2

Name: Age:

Email Address (optional):

Phone Number (optional):

Accommodations:

Roommate Preference:

Child 3

Name: Age:

Email Address (optional):

Phone Number (optional):

Accommodations:

Roommate Preference:

Child 4

Name: Age:

Email Address (optional):

Phone Number (optional):

Accommodations:

Roommate Preference:

Child 5

Name: Age:

Email Address (optional):

Phone Number (optional):

Accommodations:

Roommate Preference:

_________________________________________________________

Part Time Campers

Arrival:
Select Approx. Time: AM PM

Departure:
Select Approx. Time: AM PM

Meals Required (part timers- please check the appropriate boxes so we know how many campers will be at each meal):

Sunday supper

Monday breakfast Monday lunch Monday supper

Tuesday breakfast Tuesday lunch Tuesday supper

Wednesday breakfast Wednesday lunch Wednesday supper

Thursday breakfast Thursday lunch Thursday supper

Friday breakfast Friday lunch Friday supper

Saturday breakfast

_________________________________________________________

Please list any special needs:

Please list any special talents:

Are any of the registrants above first time campers? Yes No

If Yes, who? :

Check this box if you would like a copy of this registration form forwarded to the email address you listed at the top of this registration page.