Camper's Information

First Name

 

Entering Grade:

Middle:   Gender: F M

Last Name

 

Birth date:
(MM/DD/YYYY)

Additional Camper Information

Does your child have any known allergies?

Does your child have an IEP or other special accommodations?

Does you child need one on one assistance during camp?  Yes  No

Please describe your child's current health conditions:
 

Parents' Information
Home Address   City, State, Zip
Home Phone      
Mother's Information

First Name

 

Last Name

Occupation

 

Email

Cell Phone   Work Phone
Father's Information
First Name
  Last Name
Occupation   Email
Cell Phone   Work Phone
 
Emergency Contact

Contact 1

 

Relationship to child

Work Phone

 

Cell Phone

Contact 2   Relationship to child
Work Phone   Cell Phone
Family Physician   Phone
Authorized People to pick up camper from campus
Person 1   Relationship
Home Phone   Cell Phone
Person 2   Relationship
Home Phone   Cell Phone
Person 3   Relationship
Home Phone   Cell Phone
Swimming

Please describe your child's swimming ability by selecting from the following choices:
(Expert can swim in deep end)  

Lunch

NEW!! Lunches will be available

T-Shirts

Please note, for safety of your child, we require that all campers & staff wear a Camp Friendship Circle t-shirt each trip day. While on field trips, camp shirts distinguish our campers and staff from other visitors.

Each t-shirt costs $10

Please select your child's t-shirt size:

I would like  t-shirts.

Parental Involvement

Yes! I would like to get involved!  

Does either parent have any special resources or skills to offer our campers or counselors?
  Yes   No
If yes, please specify:  

Does either parent want to attend camp with their child? Yes No
Does either parent want to come along on trip days?  Yes No
Permission

I hereby permit my child to participate in all activities at Camp Friendship Circle – on site, off-site and trips and be transported to and from the field trips and outings. I release Camp Friendship Circle Colorado and individuals from liability in case of accident during activities related to Camp Friendship Circle Colorado, as long as normal safety procedures have been taken. I understand that my child may be dismissed during a camp day, due to illness, at the discretion of the camp, and I agree to abide by the director’s decision.

I give my child permission to participate in swimming as scheduled by Camp Friendship Circle Colorado.

The parents who signs the registration form represents that he/she has full authority to do so and will be responsible for payment of the camp fee.

Parent/Guardian Date

Tuition Information

Please check appropriate boxes

Session 1 $200 (Early bird special before March 15 $175)

Session 2 $200 (Early bird special before March 15 $175)

Session 3 $200 (Early bird special before March 15 $175) 

Session 4 $200 (Early bird special before March 15 $175)

All 4 Sessions $800 (Early bird special before March 15 $700)

Thanks to a Grant from Developmental Pathways we do have scholarships available.

Scholarships

Scholarships and payments plans are available. Please contact the office for more information.

I would like to request a:      Full Scholarship         Partial Scholarship

Sponsor a camper

Yes! I would like to enable a less fortunate child to enjoy a summer at Camp Friendship Circle.

I am enclosing: $200 for one week $400 for three weeks $800 full summer
towards tuition for another camper

       

Please charge my card below
     
CC Type   Card Number
Name on the Card      
Total Amount   Exp Date
   

 

We are looking forward to a great summer!