OVERNIGHT CAMP REGISTRATION

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Each week of Overnight camp is 325.00
Register NOW- before 4/1/10 save 25.00!
REGISTER ACCORDING TO GRADE ENTERING IN FALL OF 2010
WEEK REGISTERING FOR(required)
DVD & TSHIRT
DVD - 15.00 T-SHIRT- 15.00 DVD+T-SHIRT- 30.00
CHILD LAST NAME(required)
CHILD FIRST NAME(required)
PARENT NAME(required)
Email(valid email required)
Phone #(required)
BIRTHDATE(required)
GRADE(required)
SCHOOL ATTENDING
CHURCH ATTENDING
FIRST TIME CAMPER?
YES NO
GENDER
Male Female
ADDRESS(required)
CITY(required)
STATE AND ZIP(required)
MOTHER'S NAME(required)
MOTHER'S PHONE Number(required)
FATHER'S NAME(required)
FATHER'S PHONE (required)
EMERGENCY CONTACT PERSON #1(required)
Emergency Contact #1 Phone Number(required)
EMERGENCY CONTACT PERSON #2(required)
Emergency Contact #2 Phone Number(required)
FOOD ALLERGIES? IF YES, PLEASE LIST.(required)
LIST UP TO 2 FRIENDS TO CABIN WITH. MUST BE REQUESTED BY BOTH CAMPERS.
I understand the risks of outdoor activities and camping life, and consent to the following: I shall not hold the camp responsible of legally liable for losses of personal property or bodily injury; my child may participate in all camp activities; camp photographs/videos in which my child appears may be used in camp publicity, publications, and or promotions.
yes
HOW DID YOU HEAR ABOUT MEN-O-LAN?(required)
PAYMENT OPTIONS AFTER SUBMISSION
-25.00 EARLY REGISTRATION DISCOUNT WILL BE REFLECTED IN PAYMENT OPTIONS