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Application for Camp Robin Rogers

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									                Primary Application for Camp Robin Rogers
                             Resident Camp
                                546 S. Collett Street, Lima, Ohio 45805
                                            (419) 225-6285

 Campers Full Name   LAST              FIRST                     MIDDLE         DATE OF BIRTH



 MAILING ADDRESS                CITY                  STATE            ZIP      SEX



 MOTHERS NAME                      HOME PHONE                                  WORK PHONE



 FATHERS NAME                      HOME PHONE                                  WORK PHONE



 CAMPER LIVES WITH:               FATHER               MOTHER                  GUARDIAN

                         Child must be 8 years of age on or before June 1, 2005.
  Resident Camp will run from Sunday, August 7, 2005 through Wednesday, August 10, 2005.

              Sign-in will be from 6:00 p.m. to 7:00 p.m. on Sunday evening at the camp.

 We will have a Family Picnic at the close of camp on Wednesday, August 10th from 5:00 p.m. to
                          7:00 p.m. All family members are welcome.


                     Resident Camp Fee: For 3 nights and 3 days: $300.00
                                (this fee must be paid by July 1, 2005)

A Non-Refundable Registration fee of $25.00 must accompany this application.
  Upon receipt of this application, additional paperwork will be sent to you.
                                  (reservation confirmed with paid fee)


              Space is limited and will be on a first-come, first-served basis with deposit.

                ***There will be no transportation available for Resident Camp***
 Camp T-Shirts are available for $10.00 each. Order& PAYMENT must accompany this application.
                                         (same as Day Camp T-Shirts)
Medium Child         Large Child / Small Adult     Medium Adult       Large Adult  x Large Adult

                     DEADLINE FOR THIS APPLICATION IS:
                                JUNE 1, 2005

								
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