Ferry Beach Ecology School

Child's First Name *
Child's Last Name: *
Gender *
What grade will he/she enter in Fall 2012? *
Child's Date of Birth * MM / DD / YYYY
Parent/Guardian First Name: *
Parent/Guardian Last Name: *
Relationship to Child: *
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Your Cell Phone: * ### - ### - ####
Home Phone ### - ### - ####
Your Email: *
Preferred Method of Contact: *
Email Phone Snail Mail

Tell us how we should communicate with you
Please enroll my child in the following sessions:
July 9-13, 2012 July 23-27, 2012

Cost is $195 per camper. Camps are appropriate for campers entering 1st-6th grade for the 2012-13 school year.
Name of the school your child attends *
Please, Please tell us how you heard about our camp? From a friend, at your child's school, a newspaper ad, radio ad, at a camp fair? Is your child a returning camper? *
Do Not Fill This Out