Heit’s Point Summer Camp Registration

Please Print clearly or type. Use a separate form for each child and camp.

Camper’s Name ______Preferred Roommate______

Address ______City ______State ____ Zip ______

Home Phone ______Work Phone ______Cell Phone ______

Congregation (optional) ______City ______State ______

Our child has permission to take part in all camp activities under Heit’s Point supervision, including off site activities. Pictures of our child may be used by Heit’s Point for promotional purposes. Our child will comply with the safety requirements for specified camps. We agree to hold harmless Heit’s Point and its affiliates for all injuries or damages unless caused by gross negligence or willful neglect.

Parent/guardian signature ______Email address ______

Please print parent/guardian signature ______

Grade camper enters in fall _____Age _____Birth date ___/___/___ T-shirt size ______Gender: M F

Select camp desired:

Date / Camp / Grade / Dicription / Price / Date / Camp / Grade / Description / Price
June 14-19 / Outpost / 5-8 / 200.00 / July12-17 / Horse Camp 2 / 3-6 / 300.00
June 14-19 / High
School / 260.00 / July 12-17 / Night Owl 2 / High School / 260.00
June 21-26 / Horse Camp 1 / 3-6 / 300.00 / July 19-24 / High Adventure Camp / 7- HS / Float trip, cave, mud bar,
Amazing race / 260.00
June28- July 1 / Discovery
Mini Quest / 1-2
3-4 / 170.00
170.00 / July 24-26 / Family Camp / All Grades / 100.00
June 28- July 3 / Night Owl 1 / 5-8 / 260.00 / July 26-Aug 1 / All Camp
Band Camp / 3- HS / 260.00
July 5-10 / Water Week
Quest / 5-8
3-4 / 260.00
260.00 / Aug 1 / SUMMER FEST / everyone / FREE

Did camper attend Heit’s Point last summer? Yes No

How did you hear about Heit’s Point? ______

Does the camper have any disabilities or special needs requiring special attention by Camp staff? Yes No

(If yes, please explain on a separate sheet of paper)

Fill in amount enclosed: $75.00 deposit for each camp $______Full camp fee $ ______

(Full payment and completed medical forms are due two weeks prior to camp start date)

Please accept my donation to provide a scholarship assistance to those less fortunate $ ______

Total enclosed $______Check here if you seek financial assistance ,(Attach Campership request form).

Check Please call for any and all Credit Card payments

Please return with check payable to: Heit’s Point, 28345 Heit’s Point Ave, Lincoln, MO 65338. Deposits cannot be refunded after June 1. You will be mailed confirmation of the registration. Health forms, what to bring list, and arrival/departure times & procedures are available on line at www.heitspoint.com.

Any questions call the camp office at (660)668-2363. (Pick up is from 5 to 7 pm on the last day of that camp)