Family and Women's Programs Registration Form 2010
Adult Camper Information: (The "*" indicates a required value)
Camper's Name: *
Mailing Address: *

City: *
State: *
Zip: *
County: *

Gender: *

Has this camper attended Camp Newaygo before?
If Yes, how many years?

Home Phone: *
Day Phone:

Cell Phone: 
Email Address: (For Communication and Registration Confirmation)* 

Relationship to Youth Camper (for Family Programs only): 

How did you hear about Camp Newaygo?
Second Adult Camper Information (If applicable for family programs only. Complete a separate form for each women's program participant.)
Camper's Name:
Mailing Address:

City:
State:
Zip:
County:

Gender:

Has this camper attended Camp Newaygo before?
If Yes, how many years?

Home Phone: 
Day Phone: 

Cell Phone: 
Email Address: (For Communications)

Relationship to Youth Camper: 

How did you hear about Camp Newaygo?
Youth Camper Information: (if applicable)
Camper's Name:
Mailing Address:

City:
State:
Zip:
County:

Birth Date (xx/xx/xxxx):
Age: 
Gender:

Has this camper attended Camp Newaygo before?
If Yes, how many years?

Home Phone: 
Email Address: (for Communications)
Second Youth Camper Information: (if applicable)
Camper's Name:
Mailing Address:

City:
State:
Zip:
County:

Birth Date (xx/xx/xxxx):
Age: 
Gender:

Has this camper attended Camp Newaygo before?
If Yes, how many years?

Home Phone: 
Email Address: (for Communications)
Session Choices
 **=Price includes one adult and one child, additional children $50, adults $70
June 5 - 6 Ages 3 - 6 ** $146
# of Additional Adults:
$70/Each
# of Additional Children:
$50/Each
June 12 - 13 Ages 5 - 10 **$146
# of Additional Adults:
$70/Each
# of Additional Children:
$50/Each
Sept. 3 - Sept. 5  
# of Adults:
$105/Each
# of Kids 1 - 10
$75/Each
# of Kids 0 - 1
FREE!!
Sept. 3 - Sept. 6  
# of Adults:
$140/Each
# of Kids 1 - 10
$100/Each
# of Kids 0 - 1
FREE!!
Oct. 1 - 3 $175
  $12
Bring A Friend To Camp
Total:$0
and I qualify
     for a free Camp Newaygo T-Shirt.

     My T-Shirt size is: 

Camper 1: $0.00
Camper 2: $0.00
Camper 3:   $0.00
Camper 4: $0.00
         And I qualify for a free T-Shirt. My T-Shirt size is:
Total Discount: $0
NOTE: Bring a Friend to Camp discount only applies to Mom & Me programs and Women's Weekend.
Parent and Child Waiver, Release, and Indemnification Agreement:
I understand all deposits are nonrefundable.  All fees are due four weeks prior to camp.  I give my permission for my child to participate in all activities as they pertain to his/her camp program (including overnight, out of camp trips, and high and low ropes courses).  I understand and assume full responsibility for all risks associated with program activities which include risk or injury and/or death due to acts of God, inclement weather, slipping, falling, insect bites, equipment failure and all other circumstances inherent in outdoor settings.  I release Camp Newaygo and all of their employees, volunteers, or agents from any and all liability for use of any image generated which includes myself or any of my family members for public relations purposes including, but not limited to, articles brochures, memory books, videos, television, internet, newspaper, and magazine advertisements, Internet images, and all other Internet web site usage.  I accept full responsibility for all incurred camp fees and expenses.  I agree to assume all financial responsibility for any medical attention needed by myself or any of my family members and otherwise not covered by my insurance.  I agree to hold harmless and free from liability NCCS Camp Newaygo and convenant not to sue, including its staff, volunteers or other representatives.  I give full permission to NCCS to seek and obtain any medical treatment deemed to be necessary by NCCS staff and/or volunteers.


In case of emergency and parent/guardian is unavailable, please contact: 
Emergency Contact Name: *
Relationship: *

Home Phone: * 
Day Phone: 
Cell Phone: 
*Do you agree with the above Parent and Camper Waiver, Release, and Indemnification Agreement?

      ** By selecting 'Yes', you are effectively applying an "electronic signature" to your agreement of
      the Parent and Camper Agreement above.
         
Payment Instructions:
A NON-REFUNDABLE deposit of $50 is required during registration for each session selected.

Payment Method:   
Sub Total:$0
Fab Four Discount:$0
Total:$0
© 2010 NCCS | 6308 S. Warner Ave PO Box 149 | Fremont, MI 49412 | Phone: (231) 924-0641 | Fax: (231) 924-5594