Camper Name _________________________________ Sex _____ Birth Date ____________ Age____

Rookie ______________________________________ Sex _____ Birth Date ____________ (for campers age 15)

Program Assistant (PA) __________________________ Sex _____ Birth Date __________ (for former campers age 16)

Address_______________________________________________________________________________________________

Phone _______________________ E-Mail ___________________________ Cell __________________________

Mother's Name _______________________________ Occupation __________________________

Address (if different from camper)__________________________________________________________________________

Father's Name ________________________________Occupation __________________________

Address (if different from camper)__________________________________________________________________________

Please circle the item you would like to donate: Snacks__ Ramen__ Prizes__ Items for Camp Store

If your child is attending camp for the first time, please tell us how you heard about Camp Sejong? ______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________

Cancellation Policy: If cancellation notice is given prior to July 1, 2011, monies will be refunded less the deposit fee of $200 per camper. If notice is given after July 1, 2011 all monies will be forfeited unless a replacement camper is found, in which case monies are refunded less the deposit fee of $200 per camper.

I the undersigned understand the cancellation policy. In addition, I give Camp Sejong authorization to utilize photographs, videos or written material taken at camp for whatever promotional purposes. These photos or videos may include my child or children.

Signature ___________________________________________ Date _____________________

----------------------------cut here and retain bottom portion for your records--------------------------------------------------

TUITION: $750.00 for first camper/$700.00 per additional camper/$575.00 PA  

DUE WITH REGISTRATION: $200.00 deposit. (NON REFUNDABLE) Photo of camper (wallet size please) send with deposit or email to lpriore2@optonline.net