Resident Camp Registration Form 2012
Vanderkamp • 337 Martin Road • Cleveland, NY 13042 • 315-675-3651
Registration can also be done at www.vk.org,
See Insert for Details on Program Offerings
Name______
Gender______Age at Camp______Birth Date______Grade Completed as of 6/12______
Mailing Address______Apt #___
Town______State______Zip______
Home # ( )______# Years a resident camper at VK ______
Parent’s email/s______
Camper lives with: [] Mother [] Father [] Both Other:______T-shirt Size:______
Parent #1 Name______Cell # ( )______
Parent #2 Name______Cell # ( )______
Parent’s Signature(s)______
Denomination______Church Name______
Town______State______
[ ] I would like to download my forms online – do not mail me a Summer Camp packet.
Register & Paid in Full... Before May 1, 2012 After May 1, 2012
One Week Registration...... $369 $395
Two Week Registration...... $725 $770
Sneak-A-Peek...... $149 $175
Add our “Stable Club” for horseback riding in the mornings?……....Y / N - [ ] Basic [ ] Intermediate [ ] Advanced If yes, add +$130 to registration for Beginner and Intermediate, $175 for Advanced.
Resident Camp: See Insert for info on our program offerings
_____ July 1-7...... Freedom Week _____ July 8-14..Sneak-A-Peek/Choose Your Adventure
_____ July 15-21...... Camp S’More/Night Owls _____ July 22-28...... Sports or Creativity
_____ July 29-August 4...... Camp Outrageous _____ August 5-11...... Camp Outrageous Extended
_____ July 29-August 11…….. OUTRAGEOUS TWEEKERS!
Teen Leadership Programs(LIT) + Family Camp:
Two weeks: Fee: $575 Three weeks: $675 Deposit $100
_____ July 1-July 14...... ……...LIT 1 _____July 15-August 4…………LIT 2
_____ August 11-15………….. ..Family Camp $200 per person, max $650 per family.
Preferred Roommate? List name here______
By registering my child, I give consent to Vanderkamp Center to take photographs and digital or analog videos of my child in promotional materials for Vanderkamp Center.
If you Bring-A-First Time Friend to Vanderkamp, you and your friend receive $25 off registration fee.
Deposit of $75 per week enclosed $______Enclosed is my donation $______Total $______
If paying by check, make payable to: Vanderkamp Center.
Or charge to (circle one): Visa Mastercard American Express Discover
Signature______
Card #______
Expiration Date______CVV # (3 digits on back of card)______