Camper’s Name
________________________________________________________________________/
Male or Female
/
Birthdate
__________________/
Age at Camp
______/
Grade in Fall ‘14
________/
Address
__________________________________________________________________/
City / State / Zip
______________________________________________/
Home Phone
_______________________________/
Parent / Guardian
___________________________________________________/
Cell Phone
__________________________________/
Parent / Guardian E-mail
__________________________________________/
Camper E-mail
_______________________________________________/
Non-Parental Emergency Contact
____________________________________/
Emergency Contact Phone
___________________________/
Cabin Partner Preference (name one only)
______________________________________/
Westminster Presbyterian Church Member?
Yes No
Church/Religious Affiliation
__________________/
How I heard about Camp Henry
_______________________/
How many years at Camp?
1st 2nd 3rd 4th 5+
Race / Ethnicity (optional)
Caucasian African American Hispanic Asian/Pacific Islander Native American Other
SUMMER CAMP 2014
/
SEND COMPLETED REGISTRATION/HEALTH FORM WITH PAYMENT TO:
Camp Henry
5575 Gordon Ave. / Newaygo, MI 49337
tel
616.459.2267
fax
231.652.9460
web
email
1
Select Camp Choice /
To select your desired camp(s), mark the camp(s) you would like to register for by placing a 1 in the corresponding box for
your first choice of camp(s). To ensure that we get you registered for 2014, please select alternate time slot(s) by marking the corresponding box
with a 2 for your 2nd camp choice (for each camp that you sign up for). This will help ensure that we can accommodate you this summer.
DAY CAMP
MINI-CAMPS
REGULAR
FRONTIER
MUSIC
WATERSKI &
WAKEBOARDING
BRITISH
SOCCER
TEEN
CHALLENGE
SERVICE
CREW
CARRY-
OVERS
Asst.
Couns.
1
June 22-28
10-17 $535
3
July 6-12
10-17 $535
4
July 13-19
10-17 $535
5
July 20-26
10-17 $535
6
July 27-Aug 2 10-17 $535
7
Aug 3-9
10-17 $535
8
Aug 10-16
10-17 $535
FULL-WEEK OPTION
4
July 13-19
8-17 $535
5
July 20-26
8-17 $535
DAY-CAMP OPTION
4
July 14-18
8-17 $100
5
July 21-25
8-17 $100
NORTH MANITOU ISLAND
5
July 20-26
13-17 $535
OHIOPYLE WW RAFTING
6
July 27-Aug 2 13-17 $535
U.P. NORTH ADVENTURE
7
Aug 3-9
13-17 $535
1
June 22-28
13-17 $340
3
July 6-12
13-17 $340
4
July 13-19
13-17 $340
5
July 20-26
13-17 $340
6
July 27-Aug 2 13-17 $340
7
Aug 3-9
13-17 $340
8
Aug 10-16
13-17 $340
SUNSHINE CREW
2
June 28-July 6 13-17 $340
3-4
July 12-13
8-17 $90
4-5
July 19-20
8-17 $90
5-6
July 26-27
8-17 $90
6-7
Aug 2-3
8-17 $90
7-8
Aug 9-10
8-17 $90
June 15-21 / completed 11th-12th grade /
$340 / must complete AC application & be accepted
SELECT/
WEEK/
DATE/
AGES/
COST/
SELECT/
WEEK/
DATE/
AGES/
COST/
3
July 7-11
5-8
$205
4
July 14-18
5-8
$205
5
July 21-25
5-8
$205
ADD Transportation from Grand Rapids for $35?
Yes
No
MINI-REGULAR
Mini-1 June 15-18
7-11
$275
Mini-2 June 18-21
7-11
$275
MINI-WATERBUGS
Mini-1 June 15-18
7-11
$300
Mini-2 June 18-21
7-11
$300
MINI-FRONTIER
Mini-1 June 15-18
7-11
$300
Mini-2 June 18-21
7-11
$300
1
June 22-28
8-17 $460
3
July 6-12
8-17 $460
4
July 13-19
8-17 $460
5*
July 20-26
8-17 $460
6
July 27-Aug 2 8-17 $460
7
Aug 3-9
8-17 $460
8
Aug 10-16
8-17 $460
*CHRISTMAS THEME WEEK
7
Aug 3-9
8-17 $460
6
July 27-Aug 2 10-17 $535
7
Aug 3-9
10-17 $535
1
June 22-28
10-17 $535
3
July 6-12
10-17 $535
4
July 13-19
10-17 $535
5
July 20-26
10-17 $535
6
July 27-Aug 2 10-17 $535
7
Aug 3-9
10-17 $535
8
Aug 10-16
10-17 $535
2
3
4
5
6
7
9
10
8
Are you applying for a Scholarship?
yes no
If no, skip to number 5
Please read directions and use the Sliding
Scale in our brochure or on our website to determine your rate.
A
completed registration form, $50 deposit, and proof of income are
required in order for your request to be processed.
The award will
be noted on your confirmation statement. Scholarships are awarded
for one camp only and funds are limited.
Total Weeks selected
_______/
Total Carryovers selected
_______/
Incentive Deductions /
May not be combined with a scholarship.
Store Money /
Up to $5 for Mini-Camp; Up to $20 for Week Long Camps
_________________/
Scholarship Donation /
Please add $10 to my registration to help send
a child to camp and support the Camp Henry Scholarship Fund.
yes no
_________________/
Total Fees
_________________/
Check
MasterCard / Visa / Discover
Full Cost of Camp(s)
________________/
Payment Options
Based on my 2013 Gross Household Income and the number
of children in my household - the anticipated adjusted camper
fee from the sliding scale is
_____________/
Total Amount Enclosed
________________/
Deposit required is $100 per camp week with 50% due by March 31st. Full
payment must be received 3 weeks prior to camp date. A minimum $50
deposit is required for campers applying for a scholarship.
Card #
___________________________________________/
Exp. Date
___________/
Signature
_______________________________________________________________/
CAMP
HENRY
.
ORG
Please complete the Health Form on the reverse side.
CLIMBING
I am
a member of Westminster Church in Grand Rapids,
so I get $40 off a Full Week or $20 off for a Day/Mini Camp
Total Incentive Deductions
________________/
My brother
or sister is already coming to camp, so I
get $20 off.
.
I am
coming for more than one week, so my additional
week(s) will be $20 off.
