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)



Zip Code (required)


Fee Schedule: Camp dates & times: November 21-23, 2016 · 9:00 am - 3:00 pm
Price: $210.00 per Camper (due with enrollment)


Purchase a T-shirt
($18.00 price included with deposit)

Number of Shirts
Select Size(s)

How many small?  How many medium?  How many large?  How many extra-large?


Payment Method:

Select Card

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.