Application For Camp Registration - 2016

THE SUMMER OF 2018

54

TH

OUR

SEASON

3497 N. Clay Lick Road · Nashville, IN 47448

Mike Nickels, owner /director

812-988-2689

APPLICATION FOR REGISTRATION

CAMPER’S NAME ________________________________________________________________________________ NICKNAME______________________________ l MALE l FEMALE

PARENTS (MR., DR., MRS.) ______________________________________________________________________________________________________________________________________

HOME ADDRESS ________________________________________________________ CITY _______________________________ STATE ______________ ZIP _________________________

HOME PHONE _______________________________ WORK ___________________________ CELL ___________________________ EMAIL ________________________________________

CAMPER’S DATE OF BIRTH ________________________________ AGE DURING CAMP ________ PRESENT GRADE _________ HEIGHT _______________WEIGHT _______________

BROTHERS’ NAMES & AGES ____________________________________________________________________________________________________________________________________

SISTERS’ NAMES & AGES _______________________________________________________________________________________________________________________________________

WHY IS HE/SHE COMING TO CAMP AND IS THERE ANYTHING SPECIFICALLY YOU WOULD LIKE YOUR HIM/HER TO GAIN FROM THE EXPERIENCE? _____________________

_______________________________________________________________________________________________________________________________________________________________

FRIEND(S) YOU WOULD LIKE TO BUNK WITH _____________________________________________________________________________________________________________________

HOW DID YOU FIND OUT ABOUT CAMP PALAWOPEC? ____________________________________________________________________________________________________________

FRIEND WHO MIGHT LIKE INFORMATION (NAME AND ADDRESS) __________________________________________________________________________________________________

YOUR CHILD’S PREVIOUS CAMPING EXPERIENCE, IF ANY ________________________________________________________________________________________________________

THIS WILL BE HIS/HER ________ YEAR AT CAMP PALAWOPEC. OTHER REMARKS _________________________________________________________________________________

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EARLY ARRIVAL / LATE DEPARTURE ($100)

AIRPORT PICK-UP / DROP-OFF ($100 EACH)

CAMP PALAWOPEC 2018 SUMMER SESSIONS

CO-ED

BOYS

CO-ED

GIRLS

(AGES 8-15)

(AGES 8-15)

(AGES 8-15)

(AGES 8-15)

__

__

__

__

CO-ED SESSION 1

BOYS SESSION 1

CO-ED SESSION 3

GIRLS SESSION 1

JUNE 3 – JUNE 9

JUNE 17 – JUNE 23

JULY 1 – JULY 7

JULY 23 – JULY 28

__

__

__

CO-ED ADVENTURE TRIP

CO-ED SESSION 2

BOYS SESSION 2

CO-ED SESSION 4

JUNE 10 – JUNE 16

JUNE 24 – JUNE 30

JULY 8 – JULY 14

__

(

AGES 12-16)

__

JULY 15 – JULY 28

CO-ED SESSION 5

TBA

JULY 15 – JULY 21

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2018

Any 1 WEEK ............. $695

Any 4 WEEKS......... $2450

Any 6 weeks ........... $3475

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Any 2 WEEKS......... $1295

Any 5 weeks ........... $2950

Co-Ed Adventure...........TBA

CAMP FEES

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Any 3 WEEKS......... $1895

NOTE: We recommend at least a two-week session whenever possible. One-week sessions are offered mainly for

younger and/or first year campers. Only consecutive weeks qualify for multi-session discount.

SAVE $100 OFF YOUR CAMP FEE.

Sign up 2

NEW

Campers

and take $100 off your

MUST SIGN UP 2

NEW

CAMPERS. DO NOT COUNT YOUR OWN CAMPER. Let us know 2 new

camp fee.

campers you are signing up and we will confirm and deduct $100 from your fee when you check in.

NOTE: Please submit applications by mail, rather than email. Upon receipt of each camper’s application, we will mail necessary gear lists and physical forms. Also included

will be information sheet listing arrival and departure times, visiting hints, etc. Applications are accepted strictly on a “first come, first served” basis with bunk space for

approximately 60 campers per session. Campers may attend more than one session. Please list first and second choice.

A NOTE ABOUT CAMP FEES:

The stated fees at CAMP PALAWOPEC are all-inclusive. THERE ARE NO EXTRA CHARGES for special activities such as horseback riding,

A $100 deposit (per weekly session) with each camper’s application ensures enrollment for the dates you specify. (Co-Ed Adventure trips – $100

camp store, etc.

deposit). Balance is payable on the date of your arrival at camp. There can be no refunds unless notice of cancellation is received prior to May 1st. Make checks

payable to CAMP PALAWOPEC.

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VISA

MASTERCARD

DISCOVER

EXP. DATE _____________________________________________AMOUNT CHARGED________________________

CARD NUMBER _____________________________________________________ SIGNATURE ______________________________________________________________

I give my child permission to partake of the camping program and activities available at Camp Palawopec. I understand that the

program may include out-of-camp trips and overnights. I also give qualified medical personnel the right to take emergency action in

situations where my child may be involved and I cannot be reached.

I release and forever discharge Camp Palawopec, Inc., its officers and employees from all claims for relief for any injury which may

arise from participation in any Camp program.

DATE ________________________________________ SIGNATURE ____________________________________________________________________________