On-Line Registration Form 2008
_______________________________________________

 

Camper Name:     Gender:      

                                                                                              (mm   dd   yyyy)
Grade Finished 06/08:       Date of Birth:       E-mail:


Name of Parent or Guardian: 


Address:        City,State,Zip:               


Home Phone#:       Day Phone#:      

                                                                                                            Amount to be
Name of Church:       billed to church:    (if church agrees)

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

Please select camp sessions requested:

PROGRAM

DATES

GRADE

FEE before 5/15/08

FEE after 5/15/08
Beginner-Junior 6/22- 6/27 3-6 $300 $320
Day Camp #1 6/23 - 6/27 1-4 $160 $180
Senior High 6/29 - 7/4 9 - 12 $300 $320
Day Camp #2 6/30- 7/4 1 - 4 $160 $180
1st Timers Camp # 1 7/6 - 7/8 1 - 2 $140 $155
1st Timers Camp # 2 7/9 - 7/11 1 - 3 $140 $155
Jr. Adventure Camp 7/6- 7/11 6 - 9 $330 $350
Junior High Week 7/13 - 7/18 7 - 9 $300 $320
Beginner Week 7/20 - 7/25 3 - 4 $300 $320
Day Camp #3 7/21 - 7/25 1 - 4 $160 $180
Junior Week 7/27 - 8/1 5 - 6 $300 $320
Vacation Bible School 8/4 - 8/8 K - 6   Donation


                                             (only one name accepted)
Cabin Mate Requested:       T-shirt size:
 

Registration will be complete once a check for the $50 registration fee is received.

    Make checks payable to:   Brainerd Presbyterian Center
                                            1301 M Easton Belmont Pike
                                            Stroudsburg, PA  18360
 

PLEASE NOTE:  A parent or guardian will need to sign a consent form at Registration