ONLINE REGISTRATION FORM
Use this form to register your child. Information in bold is required and must be supplied in order to submit the form.
deposit of $200 by credit card is also required. Your registration will be submitted when you press the "send
registration" button at the end of the form. Complete one
copy for each child you wish to register.
If you prefer to register your child by mail, you may print this
form and mail it along with your deposit of $200 by check to the
address listed on the form. Complete one copy for each child you
wish to register. If you would like to pay by credit card, click
on the PayPal icon on the following page and follow the simple
Name of Camper:
Date of Birth:
Grade in School: (for '05-'06)
Type of School:
(Public, Private, Montessori, Religious, Other)
Has he or she attended a summer camp
Can He/She Swim
Can He/She ride horseback?
Special Needs (diet, allergies, etc.):
What would you like your child to accomplish
Please list any person(s) that you authorize to
visit and/or pick-up your child from camp. Under
NO circumstances will any individual that is not
authorized by you be allowed on the premise.
Name of Parent:
Home Phone: (w/area code)
Work Phone: (w/area code)
Fax: (w/area code)
How did you hear of Camp Indecon: