Journey Camp Online Registration

1. Name of Child
    First:
    Last:
    Gender Description:
    Pronoun information: she/her he/his they/them

2. Grade they will be entering in Sept 2017:

3. Age as of June 2017:

4. Name of Parent(s) or Guardians:
   

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

How did you hear about Journey Camp?

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:
    Farm Week Journey Camp for All: June 26-30, 2017, Cost: $275 to $350 sliding scale
    Session One for All: July 3-7, 2017, Cost: $275 to $350 sliding scale
    Moonseed Leadership Camp: July 17-20, 2017, Cost: $375 to $525 sliding scale
    Girls Week One: July 31-August 4, 2017, Cost: $275 to $375 sliding scale
    Girls Week Two: August 7-11, 2017, Cost: $275 to $375 sliding scale.
    Grapes Program: July 31-August 4, or August 7-11, 2017, Cost: click here for details
   

8. Payment:

Please enter the total amount you are paying for the sessions: $

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.