CHATHAM HALL RIDING CAMP

							UP WITH DOWNS SUMMER CAMP
2011 REGISTRATION FORM
Fax Completed Form to: 828-268-0087 or Mail to: 141 Doctors Dr. Boone, NC 28607

Session Dates: (June 25-29, 2012)

Child’s Full Name: ______________________ Name Preferred: ______________

Date of Birth: ___________

Parent/Guardian’s Name (s): ____________________________________________

Address: ________________________________       Phone #: ___________________

_______________________________________         Mother Cell #: ________________

Work Phone #: __________________________        Father Cell #: _________________

E-mail: __________________________________

Age/Grade: ______________      T-shirt size: __________________


How did you hear about Up with Downs Summer Camp? _______________________

______________________________________________________________________

Emergency Contact: __________________________       Phone #: ______________

Relationship to camper: _______________________

Address (if different from above): __________________________________________

Primary Physician: __________________________________

Phone Number: __________________________


Health Insurance Company: ____________________________________

Group Number: ____________________       Policy Number: _______________
Will you need transportation to or from camp for your child? Yes ______ No _____

Will anyone other than a parent or legal guardian pick up your child from camp? ______

If yes, please state name, phone number, and relationship to child: __________________

_______________________________________________________________________

Will you need to pick your child up at a time other than 10:00 to 3:00 p.m. each day?
Yes _____________ No ________________

If yes, when? _____________________________

May we use your child’s picture for promotional purposes? Yes ______ No _________

Are you interested in making a donation? Yes ________ No _______

If yes please attach it to the registration form.

Are you interested in staying for one or more days with your child? Yes _____ No _____

If yes, how many and what days? __________

Signature of Parent / Guardian ___________________________________

Date _____________________
UP WITH DOWNS SUMMER CAMP
SIGN UP AND SAMPLE ACTIVITIES
FAX COMPLETED FORM TO: 828-268-0087

____________________ will be there for the following times with Lunch and Water:
(We will provide a snack each day)

____________________ Mom or Dad’s Cell Number

____ Monday, June 25, 2012         10:00-3:00 Session

____ Tuesday, June 26, 2012        10:00-3:00 Session

____ Wednesday, June 27, 2012      10:00-3:00 Session

____ Thursday, June 28, 2012       10:00-3:00 Session

____ Thursday Night                Cookout

____ Friday, June 29, 2012         10:00-3:00 Session


Sample of Activities:

Monday 6/25, Morning Session: Exercise and Putt-Putt Golf
             Afternoon Session: Swimming at Blowing Rock Pool

Tuesday 6/26,, Morning Session: Avery County YMCA
              Afternoon Session: Creek play on Boone Fork Trail

Wednesday 6/27, Morning Session: Exercise at the Greenway and Bowling
                Afternoon Session: Movies

Thursday 6/28, Morning Session: Footsloggers Climbing Wall
               Afternoon Session: Swimming at Blowing Rock Pool

Thursday 6/28, Cookout at Camp Sky Ranch

Friday 6/29,   Morning Session: Arts and Crafts
               Afternoon Session: Summer Camp Olympics, Swimming at Blowing
               Rock Pool


We will have a van or two SUVs to transport campers and counselors. Nancy Bell and
Madge Anagnos will be designated drivers. Some of the activities will take place at
Nancy’s house at 310 Fawn Drive, Boone, NC 28607 or Madge’s house at 314
Mockingbird Lane, Blowing Rock, NC 28605.