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.
A 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 directions.
Your Name: First Last Your E-mail: REGISTRANT INFORMATION Name of Camper: First Last Nickname: Date of Birth: MM/DD/YY Sex: Male Female Height: (feet-inches) Weight: lbs. Grade in School: (for '05-'06) Type of School: (Public, Private, Montessori, Religious, Other)
Has he or she attended a summer camp before? Yes No Can He/She Swim Yes No Can He/She ride horseback? Yes No Sports/Talents/Hobbies: Special Needs (diet, allergies, etc.): What would you like your child to accomplish at camp: 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. 1. 2. 3. 4. PARENT INFORMATION Name of Parent: First Last Address: City: State: ZIP: Home Phone: (w/area code) Work Phone: (w/area code) Fax: (w/area code) E-mail: How did you hear of Camp Indecon: Comments: