Camper’s Name
________________________________________________________________________/
Male or Female
/
Birthdate
__________________/
Age at Camp
______/
Grade in Fall ‘17
________/
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 Henry?
1st 2nd 3rd 4th 5+
Race / Ethnicity (optional)
Caucasian African American Hispanic Asian/Pacific Islander Native American Other
SUMMER CAMP 2017
/
REGISTRATION FORM
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
PLEASE PRINT /
1
Select Camp Choice /
Please mark below the camp(s) that you would like to register for by placing an “x” in the corresponding box. Please
understand that many times our camps fill quickly and often sell out. If the camp(s) you select is full, someone from Camp Henry will call you to
select an alternate week or get you added to a wait list.
DAY CAMP
MINI-CAMPS
REGULAR
FRONTIER SOCCER
WAKEBOARDING MUSIC
TEEN
ADVENTURES
SERVICE
CREW
CARRY-
OVERS
LEADERSHIP
TRAINING
6
July 30-Aug 5 8-17 $540
1
June 25-July 1 10-17 $595
3
July 9-15
10-17 $595
4
July 16-22
10-17 $595
5
July 23-29
10-17 $595
6
July 30-Aug 5 10-17 $595
7
Aug 6-12
10-17 $595
8
Aug 13-19
10-17 $595
NORTH MANITOU ISLAND
4
July 16-22
13-17 $595
WHITE MOUNTAINS EXPEDITION
4
July 16-22
13-17 $595
U.P. NORTH ADVENTURE
5
July 23-29
13-17 $595
APPALACHIAN ADVENTURE
6
July 30-Aug 5 13-17 $595
RIVER CANOE ADVENTURE
7
Aug 6-12
13-17 $595
1
June 25-July 1 13-17 $390
3
July 9-15
13-17 $390
4
July 16-22
13-17 $390
5
July 23-29
13-17 $390
6
July 30-Aug 5 13-17 $390
7
Aug 6-12
13-17 $390
8
Aug 13-19
13-17 $390
3-4
July 15-16
8-17 $99
4-5
July 22-23
8-17 $99
5-6
July 29-30
8-17 $99
6-7
Aug 5-6
8-17 $99
7-8
Aug 12-13
8-17 $99
Ages: Completed 11th or 12th Grade
Session I
May 19-21
$95
Session II
June 2-4
$95
Session III
July 7-9
$95
SELECT/
WEEK/
DATE/
AGES/
COST/
SELECT/
WEEK/
DATE/
AGES/
COST/
3
July 10-14
5-8
$235
4
July 17-21
5-8
$235
5
July 24-28
5-8
$235
ADD Transportation from Grand Rapids for $35?
Yes
No
MINI-REGULAR
Mini-1 June 18-21
7-11
$310
Mini-2 June 21-24
7-11
$310
MINI-WATERBUGS
Mini-1 June 18-21
7-11
$335
Mini-2 June 21-24
7-11
$335
MINI-FRONTIER
Mini-1 June 18-21
7-11
$335
Mini-2 June 21-24
7-11
$335
1
June 25-July 1 8-17 $520
3
July 9-15
8-17 $520
4
July 16-22
8-17 $520
5
July 23-29
8-17 $520
6
July 30-Aug 5 8-17 $520
7
Aug 6-12
8-17 $520
8
Aug 13-19
8-17 $520
4
July 16-22
8-17 $540
5
July 23-29
8-17 $540
1
June 25-July 1 10-17 $595
3
July 9-15
10-17 $595
4
July 16-22
10-17 $595
5
July 23-29
10-17 $595
6
July 30-Aug 5 10-17 $595
7
Aug 6-12
10-17 $595
8
Aug 13-19
10-17 $595
3
July 9-15
10-17 $595
4
July 16-22
10-17 $595
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 /
Recommended amounts are $5 for Mini-Week Camps and
$20 for Full Week Camps
_________________/
Scholarship Donation /
Please add $20 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
Total Amount Enclosed
________________/
Deposit required is $100 per camp week. 50% is due by March 31st. The
complete cost of camp must be paid 21 days prior to camp date. A
minimum $50 deposit is required for campers applying for a scholarship.
Card #
___________________________________________/
Exp. Date
___________/
Signature
_______________________________________________________________/
Please complete the Health Form on the reverse side.
CLIMBING
Total Incentive Deductions
________________/
My brother
or sister is already coming to camp, so I
get $20 off. (applies for each additional child in a family beyond
the first child registered)
I am
coming for more than one week, so my additional
week(s) will be $20 off.
Referral Information
I am
a new camper to Camp Henry.
I was referred by
_______________________________/
who will be coming
to camp this summer.
11
My 2016 Gross Household Income was
_____________/
and I
have
______/
children in my household. My anticipated adjusted
camper fee from the sliding scale is
____________/
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
