Camp Registration Form

Name *
E-mail Address *
Camper Name *
	Male
	Female
Age *
Food Allergies *
Address *
City *
State *
Zipcode *
Method of Payment	Credit Card Check
Credit Card #
exp. date
CVV2 code (on back of card)
Name as it appears on card
Check the date(s) below for camp
	June 23-27

* Fields marked with an asterisk are required fields

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Camp fees are $280 per week per camper.

$100 non refundable deposit required per session at time of registration.

Remaining $180 due first day of class.