CAMP ELMWOOD REGISTRATION APPLICATION by xumiaomaio

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									        CAMP ELMWOOD REGISTRATION APPLICATION
               For campers ages 5-13, August 8-12, 2011

Name:__________________________________________Birth date and year_______________

School__________________________________________Entering grade (Fall 2011)_________

Favorite school subjects__________________________________________________________

Favorite hobbies, sports and activities _______________________________________________

Musical Instruments played________________________________________________________

Special needs or activity restrictions__________________________________________________

______________________________________________________________________________

Health insurance program and number________________________________________________

Parents or Guardians_______________________________________________________________

Address________________________________________________________________________

City__________________________________________________________Zip______________

Telephone (home)______________(work)_________________(cell)_______________________

Email_________________________________________________________________________l

Emergency contact (name and phones)________________________________________________


Please register the camper for
        Regular session (9:00 AM to 2:30 PM, $90.00 first camper,
                $80.00 additional campers same family)                             $____________
        Post session (until 5:30 PM, $30.00)                                       $____________
                                                     Total                         $____________
        Deposit enclosed. (Deposit of at least $20.00 per camper is requested.)    $___________
        I request campership aid in the amount of                                  $____________
        I will pay balance by July 25, 2011 in the amount of                       $___________

Except as noted above, camper is fully able and has my permission to participate in all normal camp
activities and excursions. Camp Elmwood staff has my permission to authorize emergency medical
treatment for the camper. I will pay any cost of treatment not covered by my insurance.
Camper may leave camp at end of session on her/his own. YES _____ NO _____
Persons not named above who are authorized to pick up camper:___________________________
______________________________________________________________________________
Date_______________Signature____________________________________________________

             Make checks payable to St. John's/Camp Elmwood and mail to
 Camp Elmwood, 2727 College Avenue, Berkeley, California, 94705. (Tax ID No. 94-1156850
    CAMP ELMWOOD
      An Urban Adventure for Young People Ages Five to Thirteen
                     and Teen Counselors Ages Thirteen to Eighteen

                 Monday through Friday, August 8-12, 2011
                                            .
Under the Redwoods on the Grounds of St. John's Presbyterian Church,
              2727 College Avenue, Berkeley, 94705
SCHEDULE: 9:00 AM TO 2:30 PM. Post session until 5:30 PM. Let us know if
camper will need to arrive earlier or stay later. Camp will continue until 3:30 PM on
Thursday for swim-hike and until 8:30 PM on Friday for barbeque and program.

ACTIVITIES: Basketball, volleyball, skate board half pipe, ping pong, lawn games,
art, music, drama, dance, science, cooking, swim-hike, community service,
opportunities for leadership. Our theme this year: Patience: What is it? Why should we
be patient? Are there times we should be impatient? We will explore our theme
through role play, drama, art, music, shared experiences, and stories of patient and
impatient people. We will seek to live together for one week with patience in a fun
filled, non-competitive environment.

COST: Camp Elmwood is for everyone. We request donations of $90.00 ($80.00
additional campers same family) for our regular session and $30.00 for our post
session. Camperships are available. Each camper will bring his/her lunch and a food
contribution for our Friday barbeque. We will provide morning and afternoon snacks.

Please complete and return registration application as soon as possible. For more
information and applications for our teen leadership camp (August 1-5) and teen
counselor program go to http://www.stjohnsberkeley.org or call (510) 845-6830
extension 13.




 Camp Elmwood is a community service program of St. John's Presbyterian Church, Berkeley,
     emphasizing creativity, values, and concern for others. This is our eighteenth year.

  KIDS TOGETHER, HAVING FUN, SHARING SKILLS,
              HELPING OTHERS

								
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