Fall Camp Enrollment First Camper's Name (required) Second Camper's Name Third Camper's Name First Camper's Age Second Camper's Age Third Camper's Age First Camper's Rating Second Camper's Rating Third Camper's Rating Parent Name (required) Your Email (required) Telephone Number (required) Billing Address (required) City State Zip Code (required) Fee Schedule: Camp dates & times: November 21-23, 2016 · 9:00 am - 3:00 pmPrice: $210.00 per Camper (due with enrollment) Purchase a T-shirt ($18.00 price included with deposit) Number of ShirtsSelect Size(s)smallmediumlargeextra-large How many small? How many medium? How many large? How many extra-large? Payment Method: Select CardVisaMasterCardDiscover Credit Card Number Expiration Date Security Code Disclaimer: I approve this application and certify that applicant(s) capable of such an experience. I grant permission for the applicant to participate in all camp activities understanding that competent leadership will be provided. In case of accident, the camp is authorized to secure emergency medical treatment. The camp is not responsible lost, stolen or damaged personal articles. I authorize the camp to have and use photographs, slides and video tapes of person(s) named on this application.