Camp Registration Form

SUMMER CAMP 2012 REGISTRATION FORM
Questions can be directed to: 507-467-2437, 888-800-9558,
or camps@eagle-bluff.org

Please mail completed form and $50 deposit to:

Public Program Coordinator
Eagle Bluff ELC
28097 Goodview Drive
Lanesboro, MN 55949

Please tick which camp(s) you would like to register for:

_____ Forkhorn (July 8-13, 2012)

_____ Night Owls (July 15-18, 2012)

_____ Outdoor Explorers (July 18-21, 2012)

Camper Name: ____________________________________________

Date of Birth: ______________  Age: ________  Gender: _________

Parent/Guardian: __________________________________________

Address: _________________________________________________

City: ______________________  State: _______ Zip: ____________

Contact Phone: ___________________________________________

Email: ___________________________________________________

Sponsoring Organization (if applicable): ________________________

T-Shirt Size (please circle):   Youth Medium        Youth Large       
Adult Small       Adult Medium       Adult Large       Adult XL

Each camp registration must be accompanied by a
$50 non-refundable deposit.
Please make checks payable to Eagle Bluff.

____ Check included

____ Charge only the $50 deposit to the credit card provided

____ Charge entire balance to the credit card provided

Card Number: _ _ _ _ / _ _ _ _ / _ _ _ _ / _ _ _ _   Exp. Date ____/____

Authorized Signature:___________________________________________________