Campers Name:
Date Of Birth:
Street:
Telephone:
City:
State:
Zip:
Camper E-mail Address: Sex: Male
Female
Grade finished in June 2007:
First time at PA Cherith: Yes No
Family church affiliation:
Church address:
If in Pioneer Clubs, indicate church:
Address:
Cabinmate preference:
( Note: Cabinmate must be in same division)
You have my permission for my child to attend camp, participate in its
activities, and to receive
emergency treatment if necessary. I hereby give permission to the physician selected by
the camp
director to hospitalize, secure proper treatment for, and to order injection,
anesthesia or
surgery
for my child as named above. He/She may be photographed, and pictures may be used for
promotion
and publication. Submitting this registration form online is an indication
of parent permission as stated above
_________________________________________________________
Must Have "WRITTEN" Signature of custodial parent/guardian
________________
Date
Please Place "X" In appropriate Boxes.
Boys
July
8-14, grade 1
& up
BUILT
Girls
Week 1, July
8-14, grade 5 & up
Week 2, July 15-21, grade 1 and up
Week 3, July 22-28, grade 1 and up
CILT 1
CILT 2
HORSEMANSHIP (available to grades 3 and up) $40 fee We offer three weeks of horsemanship opportunities. Our goal is
to teach beginner through intermediate horsemanship skills.
Horse Sense is available to
campers who have completed third grade or higher. This activity will teach you
about horses and how to care for them. You will learn grooming skills and
beginning riding skills. Campers usually take this level for at least two years
at camp, unless they have additional training elsewhere.
Intermediate Horsemanship is available to those who have completed and passed Horse Sense. In this class
you will improve your skills in riding and in caring for the horse and your
equipment. Campers usually take this level for at least two years or more at
camp, unless they have additional training elsewhere.
Trail Riding (May not be offered every week)
is available on a limited basis to those who have completed and passed
Intermediate Horsemanship. On occasion it will be available for the whole week;
at other times it will only be available for a ride or two during campers' free
time. Contact the camp administrator for details.
CAMPERS FEES FOR 2007:
$330 per week.
$10 per week Activity Fee.
All fees and forms are due by June 15, 2007. We cannot guarantee a space for your child unless all fees and forms are received by that
date. Please contact Paula Worden at 302-738-8186 if you have any questions.
AMOUNT ENCLOSED
$40 fee for Horsemanship
$10 Activity Fee (required)
Non-refundable deposit of
$125 per week (applied to total fee)
OR
Total Fee $330
DONATION to Camp Cherith in Pennsylvania (tax deductible)
TOTAL ENCLOSED
CREDIT CARD INFORMATION:
When paying by credit card, you must pay the full fee.
Cardholder's name (as it appears on card)
Cardholder's billing address, with zip code
Card number
Expiration date
Three digit security code from back of card
Check: MC VISA