Phone #2 (_____)___________________________  ____Home ____Work ____Cell or other

Bunkmate request ___________________________ (limit 1) (Request must be reciprocal and within the same age group. We want you to make new friends!)

REGISTRATION FEES:

$325.00/Week. $10.00 of registration fee will be deposited in the camper's Trading Post Account. A nonrefundable $75.00 deposit is required for each week your child attends camp. Balance is due in full by June 15.

REFUND POLICY:

• The $75.00 deposit fee is non-refundable and non-transferable. It is paid at the time of registration for each week reserved.
• Refunds beyond the deposit will be for illness or injury only and will be prorated. You must notify the camp office in writing with a letter from your attending physician. No refunds are given for homesickness or to children send home for violating the camper code of conduct.

FINANCIAL ASSISTANCE

Assistance is limited. Upon receipt of a camp registration form, a financial assistance form will be sent if it has been requested. Families will be asked to pay an amount based on eligibility. Camp staff will contact you regarding your request.

I would like to be considered for financial assistance [  ] Yes   [  ] No

CAMP NAZARETH CONDITIONS OF REGISTRATION

• I have completed a registration form
• I have included a $75.00 nonrefundable deposit for each week, along with this registration form and a signed ropes course authorization form and camper code of conduct form (printable copies on Required Forms page)
• I will provide a completed health form  prior to camp (printable copies on Required Forms page)
• I understand the balance of fees must be paid by June 15
• I understand that my child must follow camp rules to protect the health, safety and rights of others at camp
• I understand that I may be contacted regarding my child's infractions of the rules and may have to pick up my child if they violate the camper code of conduct
• I give permission for any photos taken of my child to be used for promotional use
• I agree with the stated information regarding program fees and refund policy
• I acknowledge that Camp Nazareth is not responsible for lost or stolen property
• I acknowledge that Camp Nazareth reserves the right to refuse any application

X________________________________________           Date_____/______/______                        Signature of Parent or Guardian

Please complete the information below for the appropriate weeks.

Mail completed registration forms and payment to: Catholic Charities Camp Nazareth, 1408 Genesee Street, Utica, NY 13502

Make checks payable to: Catholic Charities

Number of weeks attending ______ x $325.00 per week = ___________

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Office use only

Date received: __________  RCF received: ___________ CoC received: __________ Medical form received: ___________

Fees: _________ Deposit: __________ (ck #:                  )

OS Assistance: __________ Donations: __________

Balance owed: __________