Children's Summer History Camp at Hope Lodge
Fill in the following information. We will generate a registration form that you will print out, sign, and remit with payment. The camp runs August 4 through August 8, 2008 from 10am to 3pm. Attendance is limited. Campers are accepted on a first-come basis until July 18. The cost is $125 for the first child in a family ($90 for Friends members), and $95.00 for each additional family member ($75 for Friends Members). Full payment is required with your reservation. There will be a 15% processing fee for all cancelled registrations prior to July 18. No refunds will be made after July 18.
| Name | |
| Parent/Guardian | |
| Address | |
| Home Phone | |
| Work Phone | |
| Cell Phone | |
| Email Address | |
| D.O.B. | |
| School | |
| Grade Entering September | |
| Allergies | |
| Medication | |
| Health and Emergency Contact | |
|---|---|
| Name | |
| Relationship | |
| Work Phone | |
| Home Phone | |
| Cell Phone | |
| Comments | |
I hereby authorize and request the first aid personnel in charge to secure and provide emergency treatment that they deem necessary for my child(ren). In case of a mercial emergency, I understand that due effort will be made to contact a parent/guardian. In the event no one can be reached, I hereby give my permission to the physician(s) selected by the adult(s) in charge to secure treatment for, hospitalize and/or order injection(s), anesthesia or surgery for my named child(ren). I further give permission to the adult(s) in charge to escort my child on walks through the immediate neighborhood for the purpose of accessing all of the historic area facilities.