Summer Registration

Valley Mill Camp Summer Registration for 2008

After Filling Out this form, print it, submit it, sign it and mail it to: 15101 Seneca Road Germantown, MD 20874 After Filling Out this form, print it, submit it, sign it and mail it to:15101 Seneca Road Germantown, MD 20874

Camper's First Name

Nickname

Camper's Last Name

Birth Date

grade next Sept

School

Street Address

City

Zip Code

Home Phone

State

Parent 1 Work #

Parents Name 1

Parent 2 Work #

Parents Name 2

Parent 2 Cell #

E-mail

Parent 1 Cell #

Boy:

Old Camper:

Girl:

New Camper:

Girls camp only:

Check one box

Horseback Riding or Rock Climbing

Will Attend:

Season

(6/16-8/15)

Session 1

(6/16-7/25)

Session 2

(7/28- 8/15)

2nd Choice:

Parent Signature

_____________________

Date:

______________________

Parent Signature

_____________________

Date:

______________________

After Filling Out this form (1) print it, (2) submit it, (3) sign it and (4) mail it to:

Valley Mill Camp15101 Seneca Road, Germantown MD, 20874.