Application Form

Camper’s Name: Birth Date

Address:

City: State Zip:

Phone Work or Cell Phone

Email Address:

Camper’s Height: Weight: lbs. Male/Female Select One: Male Female Age:

Approximately how long has the camper been challenged by weight?

Father’s Name:

Address (if different):

Mother’s Name:

Address (if different):

Payment Information

* Two week tuition is $ 1845.00 * Four week tuition is $ 3495.00

* Tuition may be income tax deductible.

* To enroll, a deposit of $300.00 is required with this agreement. * Tuition balance is due before June 1, 2008

* A cancellation fee will be assessed according to the following schedule:

January 1- March 31, $50 fee; April 1-April 31, $100 fee; May 1-May 31, $200 fee. No refund will be given if cancellation occurs after June 1, 2008.

* A check, money order, or PayPal (use any credit card) are the methods of payment we are currently accepting.

Please enroll my child at Camp Endeavor for the 2008 season:

Session I: June 15 - June 28
Session II: June 29 - July 12
Session III: June 15 - July 12

I have read the terms of enrollment above and am familiar with the same and agree that this enrollment is acceptable to me and is subject to everything contained therein. In the event that this agreement is executed by one parent, I acknowledge that I am also acting as the agent of the other parent with the authority to so enroll my child at Camp Endeavor and to execute this agreement on his or her behalf. I recognize that Camp Endeavor relies upon the representations herein made in accepting my child. Camp Endeavor reserves the right to refuse admission based on medical/psychological history or care.

Send your payment to Camp Endeavor at: E11401 Mine Road, Baraboo WI, 53913
Or
Use the PayPal option that you will see after hitting the "Submit" button below.