2007 Summer Camp Application - our 43rd season

Mike Nickels, Owner/Director
Camp Palawopec
3497 N. Clay Lick Road
Brown County, Nashville, In 47448.

Camper's Name: ___________________________ Nickname: ___________________________ Parent's Name: ___________________________ Home Address: ___________________________ City/State/Zip: ___________________________ E-mail Address: ___________________________ Home Phone: ___________________________ Business Phone: ___________________________ Camper's Date of Birth: ___________________________ Present Age: ___________________________ Present Grade: ___________________________ Religious Preference: ___________________________ Height: ___________________________ Weight: ___________________________ Brothers' Names & Ages: ______________________________________________________ ______________________________________________________ Sisters' Names & Ages: ______________________________________________________ ______________________________________________________ Why is he/she coming to Camp: ______________________________________________________ ______________________________________________________ ______________________________________________________ Is there anything specific you would like your child to gain from the experience: ______________________________________________________ ______________________________________________________ ______________________________________________________ Specific bunkmate or tent request: ______________________________________________________ ______________________________________________________ ______________________________________________________ How did you find out about Camp Palawopec: ______________________________________________________ ______________________________________________________ ______________________________________________________ Friend who might like information (with address): ______________________________________________________ ______________________________________________________ ______________________________________________________ Your child's previous camping experience, if any: ______________________________________________________ ______________________________________________________ ______________________________________________________ How many times has your child attended Camp Palawopec: __________ Other Remarks: ______________________________________________________ ______________________________________________________ ______________________________________________________ Circle attendance session - Suggested camper ages 8 - 15 years. Campers may attend more than one session. Please indicate a first and second choice. Applications are accepted on a "first come, first served" basis with bunk space for 60 campers per session.

Boys Session:

June 17 - June 23

Boys Session:

June 24 - June 30

Boys Session:

July 1 - July 7

Coed Session:

July 8 - July 14

Coed Session:

July 15 - July 21

Coed Session:

July 22 - July 28

Girls Session:

July 29 - August 4

Girls Session:

August 5 - August 11

Adventure Trips (coed ages 13-17)

To be Announced

Camp Fees
	Any 1 week - $495
	Any 2 weeks - $895
	Any 3 weeks - $1350
	Any 4 weeks - $1695
	Any 5 weeks - $1895
	Any 6 weeks - $2295

!!Special Bonus Savings!!

• Save $25 - Sign up 1 new camper for any regular session
• Save $50 - Sign up 2 new campers for any regular session
• Save $100 - Sign up 3 new campers for any regular session
• Save $100 - Sign up a new camper for any Adventure Trip

Upon receipt of each camper's application, we will mail necessary gear lists and physical forms. Also included will be information sheet listing arrival and departure times, visiting hints, etc.

We recommend at least a two week session whenever possible. One week sessions are offered mainly for younger and/or 1st year campers. One week sessions may be combined to get the 2 week rate.

The stated fees at Camp Palawopec are all-inclusive. There are no extra charges for special activities such as horseback riding, camp store, etc. A $50 deposit (per weekly session) with each camper's application ensures enrollment for the dates you specify. (Adventure trips require $100 deposit). Balance is payable on the date of your arrival at camp. There can be no refunds unless notice of cancellation is received prior to May 1st. Make check payable to CAMP PALAWOPEC

MASTERCARD __

AMEX __

DISCOVER __

EXPIRATION DATE: _______

AMOUNT CHARGED: _______

CARD NUMBER: __________________________

SIGNATURE: __________________________

I GIVE MY CHILD PERMISSION TO PARTAKE OF THE CAMPING PROGRAM AND ACTIVITIES AVAILABLE AT CAMP PALAWOPEC. I UNDERSTAND THAT THE PROGRAM MAY INCLUDE OUT-OF-CAMP TRIPS AND OVERNIGHTS. I ALSO GIVE QUALIFIED MEDICAL PERSONNEL THE RIGHT TO TAKE EMERGENCY ACTION IN SITUATIONS WHERE MY CHILD MAY BE INVOLVED AND I CANNOT BE REACHED.

SIGNATURE ______________________________________

DATE ____________________