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Kids Culinary Summer Camp
2009 Season Camp Enrollment Form
Instructions: This is a 2 step process. This form must be fully completed and submitted by clicking the "SUBMIT" button at the bottom of this form. Step 2 is the initial payment with registration which may be done electronically by clicking the applicable "PAY NOW" button on the Registration Page.
Camper's Information
* Name:
* Address:
* City: *State:
* Zip:
Email:
* Home Phone: Cell:
* Date of Birth:
Gender: M    F
Grade Level:
( 06/07 school year )
Desired Session:
Reservation Type: Day Camp    Residential Camp

1 week session $2650.00
2 week session $4900.00
Each additional week $2000.00

Day Camp Tuition:
1 week session $1275.00
2 week session $2100.00
Each additional week $800.00

Please describe any Food Allergies or Religious Food Restrictions:
Please describe any Behavioral or Medical Conditions or Medications taken or Handicaps:
* Physician's Name:
* Physician's Phone Number:
T-Shirt Size ( Adult Sizes Only - Check One ) XS S M L XL
Will this be his/her first overnight camp?
Will (s)he be attending our camp with any other friends or relatives? If yes, whom?
Contact Parent's Information
* Name:
* Address:
* City: * State:
* Zip:
Occupation:
* Home Email:
Work Email:
* Home Phone: Cell:
Work Phone:
Other Parent or Emergency Contact
* Name:
* Address:
* City: * State:
* Zip:

* Relationship to Camper:

Occupation:
* Home Email:
Work Email:
* Home Phone: Cell:
Work Phone:
Please read the following Parent/Guardian Authorization:
Scroll using the scroll bar on the right. A hard copy of this document will be sent to you electronically for acknowledgement following your on-line registration. Thank you.
Please review all information carefully before clicking on the enrollment button below.
   
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Created by George C. Jobel    Copyright © 2006 by Kids Culinary Camp of Vermont - All Rights Reserved.