Group Hold Information Form

    Group Hold Information Form (groups registering for any summer camp program)
    FORM MUST BE FILLED OUT COMPLETELY

    Organization/Group Name:

    Organization Street Address:

    Organization City:

    Organization State:

    Organization ZIP code:

    Organization Phone Number:

    Organization Email:

    Primary Contact or Group Coordinator:

    Primary Contact Street Address:

    Primary Contact City:

    Primary Contact State:

    Primary Contact ZIP code:

    Primary Contact Phone Number:

    Primary Contact Email:

    Billing Contact (if different from Primary Contact):

    Billing Contact Street Address:

    Billing Contact City:

    Billing Contact State:

    Billing Contact ZIP code:

    Billing Contact Phone Number:

    Billing Contact Email:

    Amount organization is paying, if any: (please write n/a if not applicable)

    REQUIRED:

    Indicate the number of boys and girls you want us to hold spots for in each of the following:
    ONLY FILL IN FOR EACH WEEK YOU NEED SPOTS

    Overnight Camp One (June 6-12) Boys: Girls:

    Overnight Camp Two (June 13-19) Boys: Girls:

    Overnight Camp Three (June 20-26) Boys: Girls:

    Overnight Camp Four (July 4-10) Boys: Girls:

    Overnight Camp Five (July 11-17) Boys: Girls:

    Day Camp One (June 7-11) Boys: Girls:

    Day Camp Two (June 14-18) Boys: Girls:

    Day Camp Three (June 21-25) Boys: Girls:

    Day Camp Four (July 5-9) Boys: Girls:

    Day Camp Five (July 12-16) Boys: Girls:

    Canoe Camp (June 27-July 3) Boys: Girls:

    Enter the following characters in the box below:
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