COUNTRY ACRES DAY CAMP

2008 Camp Session

Camp Session(s) attending -

Camper's Last Name:

Camper's First Name:

Age:

DOB:

Day Camp:

Boarding Camp:

If Partial Session which day(s) will your child Attend:

Address:

City:

State:

ZIP:

Home Phone:

Mother's Name:

Father's Name:

Mother's Work #:

Father's Work #:

In case of an emergency -

list names of individuals who may be called if you can not be reached:

Ph#:

Name:

Name:

Ph#:

If someone other than the parent will pick-up your child -

list names of individuals who have your permission:

Name:

Name:

Ph#:

Ph#:

Camp Staff or Campers sometimes take photographs - check the appropriate response:

List any special information about your child's growth & development that is critical to your                                                            child's well being:

List medical needs that need attention during          Camp hours:

Camp Activities not to 

      participate in:

Email Address:

On-Line Applications must be signed at camp during enrollment.

2 June

9 June

16 June

23 June

8 June

15 June

M

T

W

T

F

None Required

Horseback

Canoeing

Swimming

Archery

Fishing

Games / Sports

Other

Pictures OK

NO Pictures

Pictures OK for Web Site

22 June

7 July

14 July

6 July

July 13