Camper Information

2010 Season: June 28 - August 13


Camper Name:
Age:
Date Of Birth (xx/xx/xxxx) :
Sex:
Address:
City:
State:
Zip Code:
School:
Grade in 2010:
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 Group/Van Requests Here:
Dates Attending:
Mini Camp (3-4 yrs old during 2010):
Full Day with van service:
$4500 (7 Weeks)
$4000 (6 Weeks)
$3500 (5 Weeks)
$3100 (4 Weeks) 		Full Day without transportation:
$3900 (7 Weeks)
$3500 (6 Weeks)
$3100 (5 Weeks)
$2800 (4 Weeks) 		Mini-camp:
$2600 (7 Weeks)
$2400 (6 Weeks)
$2200 (5 Weeks)
$2000 (4 Weeks)

Camp Policies

1. All fees include daily milk, juice, snacks, 2 camp shirts and all activities.

2. Mini-camp fees do not include transportation.

3. No camp on Monday - July 5, 2010.

4. A $500 deposit per camper is required for registration. - 10% family discount on camp fees will be applied beginning with the 2nd camper.

5. Deposits are refundable (less a $100 cancellation fee) anytime before May 15, 2010. – All fees must be paid in full by May 15, 2010.

6. I authorize the use of camper photographs for promotional purposes only.

7. I hereby give my permission for my camper(s) to participate in all camp activities.

8. I have read and agree to the above terms and conditions.

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.

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. 0612)
Security Code
Card Holders Name
Street Address:
(No City/State)
Zip Code:
Email Address:

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.