| Your Name: |
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| Street Address: |
address1
address2
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| City, State Zip: |
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| Home Telephone: |
family/parent
e-mail address:
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| EMERGENCY PHONE NUMBER (parent work #/cell #, etc.) |
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| School Attending: |
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| Instrument: |
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Your Personal
Information:
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Grade (09-10)
Gender (M/F)
Adult T-Shirt Size (S, M, L, XL)
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Do you plan to stay in the
residence hall or commute:
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Residence Hall
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I will commute
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| I want to room with (leave
bank if you want us to assign you a roommate): |
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| Comments (please include
any special requirements (dietary, physical, etc.) |
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Camp fees:
same fees as 2009, 2008, 2007, 2006, 2005 and 2004!!!
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$360.00 Resident Camper
$195.00 Non-Resident Camper
$75.00 Meal Card (Optional) |
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