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____________________