Camp Application Form - 2016
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12016 Camp Application
Complete a separate application for each child attending camp. Mail/fax completed registrations to the Kingston Regional Office. Camper
placements will be assigned as space permits.
Troop #: ___________ Non-Member? Y ..... N
Campers Name: _________________________
Address: ____________________________________________________________________
____________________________________________________________________________
Birth Date: __________________ Age as of 6/1/2016:_____________ Grade in the Fall:____________ T-shirt Size: __________
Parent/Guardian Contact:________________ Phone: _____________E-mail: __________________________________________
Alt. Parent/Guardian Contact:_____________ Phone: _____________E-mail: __________________________________________
Camp Attending
Session Name
Dates
Fee
Payment Type
Payment Calculation:
Please indicate method and amount of payment sent:
$75 deposit per camp session OR Total Camp Session Fee
$___________
Check
$___________
Non-Girl Scout Registration Fee ($15)
$___________
Cookie Credit Card
$___________
AM extended Rocky Brook Day Camp ($50 per session)
$___________
Cash
$___________
PM extended Rocky Brook Day Camp ($75 per session)
$___________
Campership applied for
$___________
Donation – Sponsor another camper (optional)
$___________
Visa ___
MasterCard ___
$___________
$___________
Total:
Account Number: ___________________
Balance due no later than May 15, 2016
Expiration Date: ____________________
Optional Program: Busing for Camp Addisone Boyce: Y
N
(no fee; stops are established based on enrollment)
Additional Information
Early Bird Enrollment Discount. Pay in full by February 29
for a 10% discount not to exceed $100 per session.
th
$75 deposit, excluding camperships, are non-refundable
Registration opens January 19, 2016.
A pre-camp packet will be sent to each camper containing further instructions and required paperwork. No campers will be admitted to camp
without the proper paperwork.
**All girls attending camp must be a registered Girl Scout. A $15 registration fee will be added to the camp fee if the girl is not already
registered.
If you have questions, please e-mail
or call 855.232.GSHH (855.232.4744)
Please check our website ( ) or the camp brochure for our complete refund policy
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