General Information

*Camper's First Name: *Camper's Last Name:

Name Preferred: *Birth Date: Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec / 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972

*Grade Next Fall: *Age at Camp: *Parent/Guardian:

*Home Phone: *Parent Email Address:

*Address:

*City: *State: AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY *Zip Code:

Church Preference: School:

Parent/Guardian Information

Mother's First Name: Mother's Last Name:

Mother's Cell Phone: Mother's Work Phone:

Mother's Occupation:

Father's First Name: Father's Last Name:

Father's Cell Phone: Father's Work Phone:

Father's Occupation:

Parents: Choose One Married Divorced Widow(er)

Enrollment Options (prices are based on registration date)

*A Camp Store Deposit of $20 per week of camp is recommended, and automatically added to your total.

*Optional Activities, additional fee required. Please check choices:

Additional Camper Information

Name of ONE preferred cabin mate (only one request will be guaranteed): Select T-shirt size: Size Child M Child L Adult S Adult M Adult L Adult XL

If you are new to camp, how did you learn about the Athens YWCO Camp? Choose One Newspaper Camp Fair Internet Friend Other

If you are a returning Athens YWCO Camper, how many previous years have you attended?

Do you have a friend who would like to receive an Athens YWCO Camp brochure?

Emergency Contact Information: Person to be called if parents cannot be reached in case of emergency.

*First Name:

*Relationship to Camper:

First Name:

Relationship to Camper: Phone:

If parents plan to be away during child's stay at camp, please complete the following

Location: Dates:

Phone:

Agreements

I recognize that certain hazards and dangers are inherent in camp events and programs and particularly, but not limited to, the activities of swimming, canoeing, and ropes course. I acknowledge that although the Athens YWCO Camp for Girls has taken safety measures to minimize the risk of injury to camp participants, the Athens YWCO Camp for Girls cannot insure nor guarantee that accidents won't happen. I further recognize and have instructed my child in the importance of knowing and abiding by the camp's rules, regulations and procedures for the safety of the camp participants. My child is responsible for her personal belongings and the Athens YWCO Camp for Girls will not be responsible for any lost, misplaced or stolen property. I give my permission for my child to attend camp and to participate in all phases of the activities including any off-site trips. I also agree that pictures and videos of my child taken at camp may be used to promote the Athens YWCO Camp for Girls. I understand that campers are not allowed to have cell phones, pagers, electronic communication devices at camp and agree to this policy.

Check here if the parents/legal guardians agree to the above statement.

I will abide by the camp rules and regulations. I understand that I will be responsible for my personal belongings while at camp and that I am not allowed to have cell phones while at camp.

Check here if the camper agrees to the above statement.