Beach Destinations
and Directions

Orca Camp
Payments

Please make checks
($300 per week)
payable to:

Rob Harrington,
11 Miramar Avenue,
San Rafael, CA  94901
(805)-448-3308

NOTE:
Checks not made payable to Rob Harrington will be returned.

Thank you.

ORCA CAMP REGISTRATION 2011
Ages 6 to 14


Please fill in every space, then print and mail this form with payment of $300 to address at bottom of this page.

  • Drop off at 9:00 a.m. and pickup promptly at 3:00 p.m.

CHECK
WEEKS
DESIRED
 July 18
July 25
Aug 1
Aug 8 Aug 15  
Note: You will be notified immediately if a particular session is filled. Email confirmation will be sent within 2 weeks of receipt of your child’s registration. Refund Policy: If notice is given at least 1 week in advance, a full refund will be made. If notice is less than 1 week, a 50% refund will be returned.
Camper Name
Birthdate / Age
Boy/Girl
Parent/Guardian
Address
 
City/State
Zip
School & Entering Grade

Home phone
Work phone
Cell Phone
Medical
Considerations:
E-mail:
PLEASE PRINT
Orca Camp cannot be held responsible for any injury that is not the fault of Orca. If my child needs medical attention Orca has my authorization to obtain it from any licensed physician or hospital as the camp deems necessary and Orca Camp may act in my place in this regard. All medical costs related to a camper’s injury are the responsibility of the camper’s parents.

Signature___________________________________________
(Parent/Guardian)

Date____________________


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