Camper First Name*
Camper Last Name*
Preferred Name or Nickname
Participant Gender*MF
Grade (as of 09/09)*
Date of Birth (mm/dd/yy)*
Address*
City*
State
Zip Code*
Country*
Phone number*
Participant email
Current School:*

2009 SESSION CHOICE(S)

Multiple Session Campers :
Check Every Session that you will Attend!

ENROLLMENT TUITION
MAC 1 Session $1,770
MAC 2 Sessions $3,400
MAC 3 Sessions $5,000
MAC Stayover I $100
MAC Stayover II $100
TA 1 Session $1,770
TA 2 Sessions $3,400
TA Stayover I $100
JAC 1 Session $750
JAC 2 Sessions $1400
Total:
Charge the following deposit to my credit card:*
Note: There is a minimum deposit of $275 per session.
Please select payment option: Charge Balance to my card
 I will make payment through other means

Adventure Camper's Code

Checking this box serves as my electronic signature and agreement for the Adventure Camper's Code of Conduct based on the above information. I Accept: 


Have you ever attended an overnight camp before?*YesNo
If yes, when and for how long

Give three reasons why you want to attend an Adventure Camp in Summer 2009
Reason 1
Reason 2
Reason 3

Referrals
Is your enrollment a result of a referral from one of our families, consultants, or alumni?
YesNo
If yes, please complete the following:
Name
Agency/Organization
Relationship

Parent/Guardian Information
Parent/Other’s First Name*
Parent/Other’s Last Name*
Home Phone:*
Address:*
City*
State*
Zip Code*
Country*
Occupation
Employer
Business Phone
Mobile Phone*
Email Address*
Marital Status

Is there a friend to whom you would like us to send information?
We will let them know that you referred us to them.
Their Name
Parent(s) Name
Street Address
City
State
Zip
I Accept: 
Camper Name/Electronic Signature*