Camp Phoenix 2013 Registration Form

Document Sample
Camp Phoenix 2013 Registration Form Powered By Docstoc
					             Camp Phoenix 2013 Registration Form/ Camper Information
Camper’s Name                                                           Age While at Camp_____________

Grade (in Sept’13):                 Date of Birth:            Sex: __________ Height: ______ Weight: ________

Name of Parent or Guardian____________________________________                           ___________

Are both parents living? _______Together? ____________

E-mail Address_________________________________________                           _________________

Des he/she have any brother(s)?___________Age(s):_________Sister(s)?__________Age(s):________________

Is there anything about your child’s physical or emotional development which is necessary for us to know in our
daily dealings you’re your child?
________________________________________________________________________
_____________________________________________________________________________
Does your child have any kind of allergy? If so, to what? __________________________________________
How severe is the reaction?___________________________________________________________________
Does he/she require medication for any of the above?_______________________________________________
Is he/she on any type of
medication?_____________________________________________________________

IMPORTANT: PLEASE DO NOT SEND ANY MEDICATION TO CAMP. PLEASE PLAN TO GIVE YOUR CHILD
MEDICATION BEFORE AND/OR AFTER THE CAMP DAY. ANY EXCEPTIONS TO THIS REGULATION MUST BE
CLEARED WITH THE CAMP OFFICE. ANY SERIOUS SENSITIVITIES SHOULD BE BROUGHT TO THE ATTENTION
OF THE CAMP DIRECTORS PRIOR TO THE CAMPER’S FIRST DAY. ANY ATTEMPT TO CONCEAL PERTINENT
MEDICAL OR EMOTIONAL INFORMATION WILL RESULT IN THE IMMEDIATE DISMISSAL FROM CAMP AND LOSS
OF ALL CAMP FEES.

       Camp Fees                                     Please Select Week (Circle your choices)
Weekly Rate- $140.00                    Week 1:      June 24 – June 28 (Nature/Native American Week)
Daily Rate- $50.00                      Week 2:      July 1 – July 5 (Science Fiction Week) (* NO Camp July 4th)
Registration Fee- $20.00 (annual fee)   Week 3:      July 8 – July 12 (Carnival Week)
**Sibling Weekly Rate- $100.00          Week 4 :     July 15 – July 19 (Water Week)
**Sibling Daily Rate -$40.00            Week 5:      July 22 – July 26 (Olympic Week)
Payment must be made in full            Week 6:      July 29 – August 2 (Jam Week)
prior to the start of the camp          Week 7 :     August 5 – August 9 (Halloween Week)
week. Camp Fees are not                 Week 8:      August 12 -August 16 (Bonanza Week)
Refundable or Transferable

We will be hosting Kids night out during the Thursday of the following weeks: Week 1 (Nature/Native American),
               Week 3 (Carnival), Week 4(Water), Week 5 (Olympic), Week 6(Jam), Week 7 (Halloween)

PARENT OR GUARDIAN SIGNATURE:
If for some reason my child is unable to attend, I understand that all payments made to Camp Phoenix will be
forfeited. Camp Phoenix does not allow for any refund of camp fees for reason of sickness, injury or inclement
weather. If for any reason the administration of Camp Phoenix should determine that the behavior of my child
is detrimental to the safety or well being of other children or staff members, I understand that they will be
prohibited from attending without refund or credit given.

Signed: _______________________________________________Date:___________________________

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:8
posted:10/21/2012
language:Latin
pages:2