Home Page     Directors     Staff     Registration     Enrollment Form     Our Program     Schedule Name Gender Grade entering Birthdate Address City State Zip E Mail Home Phone 2nd Phone Check preferred program: Week one girls grades 4- 12 Overnight ($495.00) Day camper($375.00) Early enrollment Overnight ($475.00) Early enrollment Day camper($350.00) Week two boys grades 4 - 12 Overnight($495.00) Day camper($375.00) Early enrollment Overnight($475.00) Early enrollment Day camper($350.00) Requested Roommate Must be reciprocal. Please ask requested roommate to request you as well. Guardian’s Name Relationship Home phone Work phone Emergency contact; Name Emergency contact; Phone Medical Insurance Company Policy # Name of policyholder Instructions regarding insurance Please notify notify us ASAP of any unusual medical conditions or dietary requirements. All medical and disclaimer forms will be completed at time of registration. Updated insurance information will also be completed at this time. All fields are manditory, please make sure they are complete.      All information will be treated as confidential.