Myti Oaks Day Camp

2013 Registration Form

PARENT CONTACT INFORMATION
Parent/Guardian Name(s)_________________________________________________________________________________________________
Phone (Cell) _______________________________ (Home)__________________________________ (Work)_____________________________
Address______________________________________________________________________________________________________________________
E-mail(s)______________________________________________________________________________________________________________________
Emergency Contact____________________________________________________ Phone_____________________________________________
CHILD(REN) INFORMATION
Child 1 Name_______________________________________________________________ Age____________ Grade Completed_____________
Allergies/Special Concerns__________________________________________________________________________________________________
Child 2 Name_______________________________________________________________ Age____________ Grade Completed_____________
Allergies/Special Concerns__________________________________________________________________________________________________
Child 3 Name_______________________________________________________________ Age____________ Grade Completed_____________
Allergies/Special Concerns__________________________________________________________________________________________________
Child 4 Name_______________________________________________________________ Age____________ Grade Completed_____________
Allergies/Special Concerns__________________________________________________________________________________________________
Child 5 Name_______________________________________________________________ Age____________ Grade Completed_____________
Allergies/Special Concerns__________________________________________________________________________________________________
MEDICAL RELEASE / LIABILITY WAIVER
Childs Name ________________________________________________________________________________________________________________ _
(Please list each childs name)
has my permission to participate in the activities of MYTI OAKS DAY CAMP. I will n ot hold the Christian Conference Center, MYTI OAKS DAY CAMP, or
its staff responsible in the event of an accident or injury, either emotional or physical in nature. I also give consent for immediate medical attention to
be rendered by the nearest emergency facility. I understand that all efforts will be made to contact me.

Parents/Guardians Signature______________________________________________________________________ Date________________

CAMP REGISTRATION
Child 1 Name__________________________________________________________________________________________________
Check All Camps This Child Is Attending:

Volleyball Camp :: June 10-14 :: 9a-Noon

Volleyball Camp :: July 8-12 :: 9a-Noon

Musical Camp :: June 17-28 :: 9a-1:30p

Musical Camp :: July 15-26 :: 9a-1:30p

Child 2 Name_________________________________________________________________________________________________ ____

Check All Camps This Child Is Attending:

Volleyball Camp :: June 10-14 :: 9a-Noon

Volleyball Camp :: July 8-12 :: 9a-Noon

Musical Camp :: June 17-28 :: 9a-1:30p

Musical Camp :: July 15-26 :: 9a-1:30p

Child 3 Name__________________________________________________________________________________________________
Check All Camps This Child Is Attending:

Volleyball Camp :: June 10-14 :: 9a-Noon

Volleyball Camp :: July 8-12 :: 9a-Noon

Musical Camp :: June 17-28 :: 9a-1:30p

Musical Camp :: July 15-26 :: 9a-1:30p

Child 4 Name______________________________________________________________________________________________ ____

Check All Camps This Child Is Attending:

Volleyball Camp :: June 10-14 :: 9a-Noon

Volleyball Camp :: July 8-12 :: 9a-Noon

Musical Camp :: June 17-28 :: 9a-1:30p

Musical Camp :: July 15-26 :: 9a-1:30p

Child 5 Name__________________________________________________________________________________________________
Check All Camps This Child Is Attending:

Volleyball Camp :: June 10-14 :: 9a-Noon

Volleyball Camp :: July 8-12 :: 9a-Noon

Musical Camp :: June 17-28 :: 9a-1:30p

Musical Camp :: July 15-26 :: 9a-1:30p

PRICING
Volleyball Camp (1 week) :: $30 per camper Musical Camp (2 weeks) :: $50 per camper
*Special Family Pricing: Two siblings should only cost $75 for two weeks of camp, and one family should pay no more
than $100 for two weeks of camp no matter how many children attend.

Total Amount Due $ ______________________________________

Please make checks payable to: Christian Conference Center

*Financial Assistance is Available