SHASTA CAMP CHERITH
REGISTRATION FORM

(Please use one form per camper)

Camper's Name :
Camper's Home Phone :
Address :
City / State / Zip :
Date of Birth :
Grade Completed as of June Prior to Camp :
Church Camper Attends :
Cabinmate Preference (must be same grade) :
Name of Parent(s) / Guardian(s) :
Parent(s) / Guardian(s) Work Phone :

I am registering for:	GIRLS' CAMP
	Week 1
	Explorers
	CILT

In order to reserve your child's place at camp, you must include with your registration form a $50.00 nonrefundable deposit.

The camper named above, and whose signature appears below, agrees to conduct themselves in a manner pleasing to the Lord. The use of tobacco, alcohol, illegal drugs, profanity and abusive language will not be allowed at camp. Camper agrees to respect the authority of the camp staff and the rights of other campers. You have my permission for my child to attend camp and to participate in the activities, to receive emergency treatment if necessary, and to be photographed and her/his pictures used for camp promotion including brochures and website. We agree to comply with this statement knowing that failure to do so may result in dismissal from the camp without refund.

Parent(s)/Guradian(s) Signature:		Date:
Camper's Signature:		Date:

Mail completed forms with payment to : Mrs. Eleanor Davis, Registrar 1135 Dean Ave. San Jose, CA 95125 (408) 289-9261

Please make checks payable to : SHASTA CAMP CHERITH