Summer Camp '97 Registration Form

Below is the actual registration form directly extracted from the Registration Packet.
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Please fill it out and return to the address at the bottom.

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WAIVER & REGISTRATION FORM

PLEASE COPY THIS PAGE OR FILL OUT A SEPARATE FORM FOR EACH ADULT ATTENDING.

I understand that Summer Camp will offer a large variety of activities that can be physically, mentally, or emotionally engaging. The level of my participation in any of the activities is at all times completely my choice. I may stop or say "no" at any time.

In the event of an emergency I give the Summer Camp '97 Staff permission to call an ambulance or physician. I release Summer Camp Staff and NFNC from all liability for any injury to me from my participation in any of the activities. This release also applies to the minors listed below for whom I am responsible: Participant's Signature (if at least 18 years old):

Days and

Please check the days

A 'day' runs from

Fri 8^th-Sat 9^th
Sat 9^th-Sun 10^th
Sun 10^th-Mon 11^th
Mon 11^th-Tue 12^th
Tue 12^th-Wed 13^th
Postmarked after June 30^st Evening, no dinner $25.
1 day $65/day
2 days $55/day
3 days $50/day
4-6 days $45/day
7+days $360.flat
Student w/ID $290

Age < 7 are free.

RATES

you plan to attend:

dinner to dinner.

Wed 13^th-Thu 14^th
Thu 14^th-Fri 15^th
Fri 15^th-Sat 16^th
Sat 16^th-Sun 17^th
All Days
Number of
days attending: _______

times the Rate: _______

Subtotal: $_________
Add Children

aged 7-17: _______
at $15 each day
or $90 for all: _______

Subtotal: $_________

Total Due: $_________ ___________________________________ Date:_______________
Name: _________________________________________________
Address: _______________________________________________
Cty, St, Zp: ____________________________________________
Home Tel. (______)- ____________________________________
E-mail Address: ________________________________________

Emergency Contact and
Phone:___________________________ (_____) ______________
Minors'
Names ________________________ DoB: _______________
________________________ _______________
________________________ _______________
Parent/Guardian
Signature: ____________________________Date: ___________
How did you
hear about SC'97: ______________________________________

Please Mail Check with this Registration Form to
SC'97, PO Box 160, Forest Grove, OR 97116
Write to request information on our very limited work-exchange program, or email to keithb@nfnc.org