2005 Summer Camps
Registration Form
CAMPER INFO
NOTE: Make sure to SELECT either a 3 or 5 day camp for the desired week.
Camper Name(s)
Age
June
20-24
June-July
27-1
July
6-8*
July
11-15
July
18-22
July
25-29
Aug
1-5
Aug
8-12
Sub-
total
1.
Select
3 Day
5 Day
Select
3 Day
5 Day
Select
3 Day
Select
3 Day
5 Day
Select
3 Day
5 Day
Select
3 Day
5 Day
Select
3 Day
5 Day
Select
3 Day
5 Day
2.
Select
3 Day
5 Day
Select
3 Day
5 Day
Select
3 Day
Select
3 Day
5 Day
Select
3 Day
5 Day
Select
3 Day
5 Day
Select
3 Day
5 Day
Select
3 Day
5 Day
3.
Select
3 Day
5 Day
Select
3 Day
5 Day
Select
3 Day
Select
3 Day
5 Day
Select
3 Day
5 Day
Select
3 Day
5 Day
Select
3 Day
5 Day
Select
3 Day
5 Day
4.
Select
3 Day
5 Day
Select
3 Day
5 Day
Select
3 Day
Select
3 Day
5 Day
Select
3 Day
5 Day
Select
3 Day
5 Day
Select
3 Day
5 Day
Select
3 Day
5 Day
* July 6-8:
5 day camp not available this week
Camp Prices:
5-Day Camps
$280
3-Day Camps
$240
Total
PARENT / PAYMENT INFO
Name of Parent
or Guardian
Address
City
State
Zip
Home Phone
Business Phone
(Cell Phone or Pager)
Email Address
Payment Method
Visa,
Mastercard
Name on Credit Card
Credit Card Number
Credit Card Expire
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01
02
03
04
05
06
07
08
09
10
11
12
/
--
2005
2006
2007
2008
2009
2010
2011
SURVEY
How did you hear about our camps?
Select
Newspaper Ad
RSBC Mailer
Friend or Relative
RSBC Staff
Other
If other, please specify
Would you like a brochure sent?
Yes,
No
Additional Commentents
Telephone: (818) 788-3467 Toll-Free: (888) 448-7722 FAX: (818) 788-8469
