Fun Camp Application | Camp Birch Knoll

fun camp brochure

Fill out the last page and send it in, or register online below!

camp birch knoll

2022 Application for Enrollment

August 11-17

Camper First Name

Camper Last Name

Grade

Birthday

Age

Camper Email

Street Address

Street Address Line 2

City

State

Zip Code

Country

This will be my camper's

year at camp

Does your camper live with both parents?

Yes

If No

Separated/Divorced

Mother Deceased

Father Deceased

Other

Mother Name

Mother Email

Mother Phone

Mother Address

Mother Occupation

Friend Request

Father Name

Father Email

Father Phone

Father Address

Father Occupation

Emergency Contact Name

Emergency Contact Phone

My camper is: (choose one)

Able to participate in all activities

Should be restricted in the following areas:

Parent’s Authorization: I hereby give my daughter permission to attend Camp Birch Knoll and consent to the emergency care of my daughter in case of illness if I cannot be contacted. I understand that expenses for medical care beyond the camp health center are the responsibility of the parent or guardian and that the camp does not provide accident or medical insurance. I understand that smoking, drinking, or use of drugs are not permitted and are cause for immediate dismissal from camp.

Your Signature

Thank you!