Summer Camp Registration Form 2008

 

Contact
Office 419 938-3715 4654 Pleasant Hill Road Perrysville, OH 44864

info@phoc.org

 

 


Camper Information
Camper's Last Name First Name
Home Address
City State Zip
Birth Date Age Male Female
Camp Preference (All Dates 2008)- a $75 deposit is requred to reserve space
Please check the camp(s) you are registering for. Each camper must be registered separately, however multiple camps may be selected for any single camper.
Adventure Camps Horselover Camps
June 15-20, Ages 7-10, $299 June 15-20, Ages 10-11, $385
June 22-27, Ages 9-12, $299 June 22-27, Ages 11-13, $385
July 6-11, Ages 7-10, $299 July 6-11, Ages 10-11, $385
July 13-18, Ages 9-12, $299 July 13-18, Ages 11-13 $385
July 27- August 1, Ages 8-11, $299  July 27- August 1, Ages 8-11, $385
Teen Adventures (ages 13-16) Mini Camp
Teen Adventure Camp, July 20-25, $335 June 29-July 2, Ages 6-8, $199
Teen Horselovers, July 20-25, $385 Kinder Camp
Whitewater Adventure, July 2 - 5, $299 Kinder Camp, June 13-14, $75
Horseback Riding (N/A for Horselover and Cowboy camps and Whitewater Adventure)
YES, I would like to add a Trail Ride (Horseback) during the week.Include $18 to your camp fee. (Campers under age 8 receive a staff led pony ride. Include $8 for this.)
Cabin mate Requests
If your camper would like to be in the same cabin as his/ her friend, please indicate their name here. Cabin Mates should be no more than 2 years apart. To be honored, the cabin mate you request here must also request you. Limit 2.
Cabin Mate 1 Cabin Mate 2
Parent or Guardian Information
Please list the parent or guardian who is responsible for enrolling camper at Pleasant Hill Outdoor Center.
Name Home Phone
Cell Phone Emergency
E-Mail (for camp updates and information)
Address if different from camper
City State Zip
Financial Policy / Media Release Must must be checked.
Yes, I understand that my deposit is non refundable and is required to reserved space. Additional fees paid are non refundable after June 1. I also agree that Pleasant Hill Outdoor Center may photograph and or video my camper while at camp for use in its promotional materials.
Third Party Sponsors
If anyone other than the parent or guardian is sponsoring your camper and has agreed to pay any portion of the camp fee, please list their information below. If for any reason payment is not made by the sponsor, the parent or guardian will be responsible.
Name Amount to be Paid $
Address
City State Zip
Phone
Payment Method
I prefer to pay with a check in the mail. (camper registration cannot be confirmed until deposit is received)
I prefer to pay with a credit/ debit card online now.
Please call me and take my credit/ debit card by phone.
Please tell us your best contact number:
.


Note:
As a non profit summer camp our goal is to provide a lifelong camp memory for every camper. We intentionally keep our fees low in an effort to make our quality summer experience accessible to more families and rely on the gifts from friends and supporters to cover the difference. If you have been blessed and would like to include a donation beyond your camp fee to support the camp simply check below. Your donation will be noted on your statement of account. Your gifts are tax deductible since we are recognized by the IRS as a 501 (c) 3 exempt organization.
No Thanks Donate $50 Donate $30 Donate $20 Donate $10