2008 Summer Camp Registration
Campers Full Name:    
Address Line 1: Address Line 2:
City / Town: State:
Zip Code: Email:
       
Age in Summer: Birthdate:
Sex: Male     Female Age:
School:    
       
Mothers Name:  
Mothers Primary Phone: Home    Work    Cell 
Mothers Secondary Phone: Home    Work    Cell 
Fathers Name:  
Fathers Daytime Phone: Home    Work    Cell 
Fathers Alternate Phone: Who:
       
 

Allergies, Food Restrictions, Disabilities, Other Areas of Concern:
 

 

Medication used by camper on a regular basis:

 

I wish to register for the following weeks:
Session A Colonial American Life
Art Colony Experience		 June 27 - July 3
July 7 - 11		 Grades 4 - 7
Grades 4 - 7
Session B Colonial American Life
Art Colony Experience		 July 14 - 18
July 21 - 25		 Grades 2 - 3
Grades 2 - 3
Session C Colonial American Life
Art Colony Experience		 July 28 - Aug 1
Aug 4 - 8		 Grades 2 - 3
Grades 2 - 3
Split Session Option (Indicate 2 non-consecutive weeks)
       
How did you hear about the camp programs at Bush-Holley?
Bush-Holley Website Camp Brochure Prior Attendance Community Answers
Word of Mouth During visit to site Newspaper Ad Kidsevents.com
Other
       
  I am a: Member     Non-Member