Snow Camp Registration Form

Contact
Office 419 938-3715

info@phoc.org

Questions? Pick up the phone now and give us a call at 419 938-3715

Snow Camp Registration Form 2010

CAMPER INFORMATION

Camper's Last Name First Name

Home Address

City State Zip

Date of Birth Male Female .....No Gender Selected

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 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 retreat fee is non refundable and is required to reserved space. 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

Note: Please feel free to call our office with any questions you may have or e-mail info@phoc.org or director@phoc.org

PAYMENT METHOD (a minimum of $75 toward your camp fee is required to reserve space)

		Pay with a Check in the mail. Registration cannot be confirmed until payment is received.
		Pay Online Now
		Please Call me for a Payment by Phone Please give us the best number to contact you at