Cascade Camp Cherith Registration Form

2017 Camper Registration Form

One camper per form. Please complete this form in Microsoft Word, print, sign, and mail by June 15 with payment to:

Cascade Camp CedarbrookJayne Blackburn, Registrar
13311 3rd Ave SWBurien WA 98146

Name / Phone / Sex
MF / Grade in fall
Address / City / State / Zip
Cabinmate preference. (Must be same grade.) / Camper Birthday / Camper Age
Parent(s)/Guardian with whom camper lives / Parent’s e-mail address
Church camper attends
Early payment discount:if payment in full is postmarked by April 30, deduct $30.00 from *full week camp fee.
Classic Camp
Boys Camp
Girls Camp
Girls Camp
Voyager Camp
Voyager Boys Camp
Voyager Girls Camp
Horse Specialty Camp
Girls HSC
CILT
Boys Camp with CILT I
Boys Camp with CILT II
Girls Camp with CILT I
Girls Camp with CILT II
Horsemanship Activityper week / July 9– 15
July 16 – 22
July 23 – 29
July 9– 11
July 23 – 25
July 9– 15
July 9– 15, plus one spring weekend
July 9 – 15, plus one spring weekend
July 16 – 22 and July 23 – 29
July 16 – 22 and July 23 – 29
Available for boys and girls during Classic Camps / *$420
*$420
*$420
$150
$150
*$645
*$505
*$420
*$690
*$520
$110 / Cost
Outposting Specialty Weekend (Included in Girls CILT I and II costs)$95
Your camp fee includes a T-shirt and a camp picture. Please indicate T-shirt size.Sizes may not be available after June 1. / Camper T-shirt size
YouthMLAdultSMLXLXXL
If total camp fee is not enclosed, a $50 non-refundable deposit is due with registration.Registration form and the ENTIRE feeis due by June 15, unless special arrangements have been made with the camp registrar. After June 15, a $40 late registration fee will be assessed.
Please review our refund policy, found on the Forms page of our camp website.
Note: $25 NSF check fee. / *Early payment discount–
Discounts applicable ONLY if payment in full is postmarked by discount due date.
Late registration fee
Total enclosed$
Camper registrations are accepted in the order received, regardless of race, color or national origin. Upon receipt, additional information will be sent to you. / Charge: VISAMC#Exp Date CVV
SignatureDate
Make checks payable to:Cascade Camp Cedarbrook
Permission Agreement
Cascade Camp Cedarbrook has my permission for my child to attend camp, to participate in its activities, and to receive emergency treatment, if necessary. He/she may be photographed and pictures may be used for camp promotion.
Parent/Guardian Date
signature required / Horsemanship Class and Trail Rides Waiver
The undersigned has sent a child or children to Cascade Camp Cedarbrook, a non-profit Washington Corporation, to participate in the horsemanship program. Said parents or guardians understand that the program has some inherent risks and do hereby release Cascade Camp Cedarbrook and all of its staff and agents from any claims for injuries to or death of minor children involved in said horsemanship program, and the undersigned agrees to hold harmless Cascade Camp Cedarbrook and its staff and agents from any claim by any child injured in said program.
Parent/Guardian signatureDate