Welcome to Online Registration
Help us make this the best camp experience you have ever had!  Please make sure to fill out all of the information completely.
Sign in to Google to save your progress. Learn more
Which week(s) will you be attending? *
You can choose multiple weeks.  Sunday through Friday ONLY.  Camp "R" does not offer weekend accommodations.
Required
CAMPER INFORMATION
Name: *
First & Last
Address: *
street, city, state, zip
Gender: *
Required
Birthday & Age *
School: *
T-Shirt Size *
Adult Sizes
How did you hear about Camp "R"? *
Camper lives with: *
Parents/Guardian Name(s): *
Email Address *
Contact Information: *
Please include home phone #s AND cell phone #s
ADDITIONAL INFORMATION NEEDED:
How will you be getting to and from camp? *
Name of Insurance Company: *
Last 4 digits of policy number: *
How do you wish to pay? *
Credit card payments must call into the main office, (412) 621-3342, to provide your credit card information
Amount Due: *
Multi-week discounts already applied
Additional Paperwork *
all medical forms and final balance are due one week prior to scheduled session
By submitting this form, it is my desire that the child named above attend Camp "R" for the session(s) checked.  I hereby waive claims against Camp "R" and it's employees for any and all injuries which might arise from attending camp. In the case of apparent injury or illness, I want my child sent to a reliable hospital and medical assistance called at once, for which I expect to pay the usual charges. I am also aware that my son/daughter may be sent home, without refund, for flagrant violations of camp rules. *
Parent/Guardian should review the above release and sign name below.  
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report