Journey Camp - Sarah Pirtle

Journey Camp Registration Form

1. Name of Child:
    First
    Last
    Gender: Male / Female

2. Grade they will be entering in Sept 2012:

3. Age as of June 2012:

4. Name of Parent(s) or Guardians:

5. Important: Have you read the Note to Parents?

6. Contact Information:

Parent 1

Your Mailing Address (with Zip):

Your Email:

Home Phone:

Work Phone:

Parent 2

Your Mailing Address (with Zip):

Your Email:

Home Phone:

Work Phone:

7. Session(s) you are registering for:
    Day Camp for Boys and Girls: July 2-6, 2012, Cost: $250 to $300 sliding scale
    Hilltown Journey Camp: July 16-20, 2012, Cost: $250 to $300 sliding scale
    Moonseed Leadership Camp for Girls: July 30 - Aug 2, 2012, Cost: $350 to $500 sliding scale
    Girls Week: August 6-10, 2012, Cost: $275 to $375 sliding scale
    Girls Week: August 13-17, 2012, Cost: $275 to $375 sliding scale.
    Grapes Program: August 6-10, and August 13-17, Cost: click here for details

8. Payment:

Please enter the specific amount you are paying: $

Choose One
    I agree to send half the cost March 1st and half May 1st.
    I will send payment in full this month.
    I will email my plan for a different payment schedule.

Finances: Please make a contribution toward our scholarship fund if able.
Check here if you are sending a letter to apply for a partial scholarship.

10. Support at Camp: Please reply below or email a longer letter.

a. Any medical, physical, health needs such as food allergies, medications, or special physical needs or restrictions?

b. We want every camper to have our support. Are there any current issues or needs we should be aware of?

c. What assistance will your child need in following the conduct code?

NOTE: Email registrations are not complete until the $50 registration fee is received. Please send $50 for each child and each session. It goes toward the final fee.