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, 2012, monies will be refunded less the deposit fee of $200 per camper. If notice is given after July 1, 2012 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 Sejong Cultural Education, Inc. 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 _____________________

Comments:_________________________________________________________________________

----------------------------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