Camper Information

2012 Season: June 27 - August 15


Camper Name:
Age:
Date Of Birth (xx/xx/xxxx) :
Sex:
Address:
City:
State:
Zip Code:
School:
Grade in 2012:
Home Phone Number:
Email Address:
Please Specify Nearest Cross Streets:
Father's Name:
Father's Cell Phone:
Father's Work Phone:
Mother's Name:
Mother's Cell Phone:
Mother's Work Phone:
Please Note Any Food Allergies:
Please Note Any Group/Van Requests Here:
Dates Attending:
Mini Camp (3-4 yrs old during 2012):

 

DUE TO THE EXTENDED SCHOOL YEAR-THE 2012 CAMPING SEASON IS SCHEDULED FROM WEDNESDAY TO WEDNESDAY-ANY SHORTENED WEEK WILL BE PRO-RATED ACCORDINGLY

Full Day with van service:
$4700 (7 Weeks) $4200 (6 Weeks) $3700 (5 Weeks) $3200 (4 Weeks) $2400 (3 Weeks) $1600 (2 Weeks)

Full Day without transportation:
$4100 (7 Weeks)
$3700 (6 Weeks)
$3300 (5 Weeks)
$2800 (4 Weeks)
$2100 (3 Weeks)
$1400 (2 Weeks) 		Mini-camp (No van Service available):
$2700 (7 Weeks)
$2500 (6 Weeks)
$2300 (5 Weeks)
$2000 (4 Weeks)
$1500 (3 Weeks)
$1000 (2 Weeks)

Camp Policies

All fees include daily milk, juice, snacks, 2 camp shirts and all activities.- No camp on Wednesday July 4, 2012. A $500 deposit per camper is required for registration. - 10% family discount on camp fees will be applied beginning with the 2nd camper.-Deposits are refundable (less a $100 cancellation fee) anytime before June 1, 2012. All fees must be paid in full by June 1, 2012.

I authorize the use of camper photographs for promotional purposes only and give my permission for my camper(s) to participate in all camp activities.


Payment Information

Pay by check and make payable to Camp Pelican
(listing posted upon receipt of payment)
Mail to:

Camp Pelican
15 East Putnam Avenue #3330
Greenwich CT 06830
Charge To: VISA Mastercard
Amount:
Credit Card Number
Expiration Date
(ex. 0614)
Security Code
Card Holders Name
Street Address:
(No City/State)
Zip Code:

PRIVACY STATEMENT: Camp Pelican does not share any information provided to us with any individuals or companies.  Information you provide is not given or sold to any individuals or companies.

By clicking the submit button, you agree to all conditions stated above and understand that a deposit will be charged to your credit card.