REGISTRATION FORM
I am registering my child for:
Please complete this form and return it to the following address. If you are registering more than one child, please use one form per child
Environmental Resource Center P.O. Box 819 Ketchum, ID 83340 Name of Participant:
[ ] Male
Grade for 2011-12 School Year:
[ ] [ ] [ ] Discounts
[ ] Female
[ ]
- $35
- $25
[ ]
THEN, also take Family Discount (for multiple family members, or one child in two camps; only one discount per family) if applies
-$50
Scholarship [ ]
Emergency Contact Name:
T-Shirt Size:
ERC Family Membership Discount
Early Bird Registration Discount Before May 1
Parent/Guardian Name:
[ ]
Relationship to Participant:
Give or Receive Scholarship Assistance I would like to receive scholarship support information and I am enclosing my $50 deposit (per camp to hold space) We would like make a donation to help out another family send a child to EcoCamp Payment Total
[ ] No
Make sure your cabinmate also requests you. We will do our best, but there are no guarantees.
Cabinmate Request:
$350
[ ]
City, State & Zip:
[ ] Yes
$430
OR
Mailing Address:
Has child attended EcoCamp before?
$350
Choose ONE from section in gray, if applies
Phone Number:
Email Address:
Phone:
EcoCamp: Chasing Wild (for rising 4th-7th graders, July 18-22) EcoCamp: Adventure Aquatic (includes river rafting trip Friday) (for rising 4th-7th graders, July 25-29) EcoCamp: Night Stalkers (for rising 4th-7th graders, Aug 8-12)
Youth:
[ ] Small
[ ] Medium
[ ] Large
Adult:
[ ] Small
[ ] Medium
[ ] Large
Payment Method Name on Card:
[ ] XXL
Dietary or Medical Restrictions:
City, State & Zip: E-mail Address for Receipt: Credit Card Number:
Please mark how you heard about EcoCamp – Newspaper ad Newspaper article ERC Mailing or Newsletter BCSD Bridges Attended Last Year ERC website Sun Valley Online School Flyer Other (please describe)
$ $
[ ] Check [ ] MasterCard [ ] Visa [ ] AMEX [ ] Discover
Card Billing Address: [ ] XL
$50
3-digit Security Code from back of card:
Expiration Date:
Signature: Payment plans may be available. Contact Lisa Horton at 208.726.4333