2017 OVERNIGHT CAMP REGISTRATION
Thank you for your interest in WIND DANCE ADVENTURE CAMPS - EMBRACING THE EARTH
16th Camp Summer
STEP 1 of 4 - Complete this form
We have a limited number of camper spaces and we encourage you to register early. Knowing how many campers enables us to hire the appropriate number of guides, keeping the adult/camper ratio well balanced.
REGISTRATION DUE MAY 15
If you are registering after May 15, please inquire about openings

304-258-4672 wind.dance@frontier.com

PRINTABLE REGISTRATION OPTION
If you prefer, please visit the www.WindDanceFarm.org web side, download the printable registration form and mail it to:

Wind Dance Farm and Earth Ed. Center
649 Virginia Line Road | Berkeley Springs, WV 25411

COMPLETE THIS FORM FOR ONE CAMPER
CAMPERS MAY ATTEND MULTIPLE AGE-APPROPRIATE CAMPS
Choose a single or combination of camps for your camper:
CAMP GUIDE ASSISTANT (CGA)
We are accepting applications for a Camp Guide Assistant (CGA) for the Youth Camp July 9 - July 15. CGA's help with camp management and partake in activities. Minimum age is 15.

CGA fee is $200, plus $25.00 registration fee. Please contact Wind Dance at 304-258-4672 or wind.dance@frontier.com

Overseeing use of tools older campers guide young ones while constructing an out building.
Camper's Name
Your answer
Camper's age at time of camp
Your answer
Camper's family address (street, city, state, zip code)
Your answer
Camper's family phone with area code
Your answer
Camper's parent name(s)
Your answer
Camper's parent(s) address if different
Your answer
Camper's parent(s) cell phone number
Your answer
Camper's parent(s) work phone number
Your answer
Camper's parent(s) email address
Your answer
Campers learned techniques to survive in the wilderness with AR, who received training through Tom Brown programs, and Kevin a camp guide for five years and an Eagle Scout.
CAMPER EMERGENCY CONTACT
Questions? 304-258-4672 wind.dance@frontier.com
EMERGENCY CONTACT NAME
Your answer
EMERGENCY CONTACT PHONE
Your answer
EMERGENCY CONTACT SECOND PHONE
Your answer
EMERGENCY CONTACT RELATION TO CAMPER
Your answer
CAMPER MEDICAL INFORMATION
Questions? 304-258-4672 wind.dance@frontier.com
HEALTH INSURANCE COMPANY
Your answer
PLAN/POLICY NO.
Your answer
NAME OF INSURED PERSON
Your answer
INSURED PERSON'S PHONE NUMBER + AREA CODE
Your answer
PRIMARY PHYSICIAN NAME
Your answer
PRIMARY PHYSICIAN PHONE NUMBER + AREA CODE
Your answer
CAMPER ALLERGIES - LIST ALL OR "NONE"
Your answer
MEDICATION YOU CHILD WILL TAKE DURING CAMP - LIST ALL or type "NONE"
Your answer
MEDICATION - HOW OFTEN ADMINISTERED or type "NA"
Your answer
Do you give permission to administer homeopathy remedies to your child if necessary?
Does your child's diet include meat?
Foods you prefer your child not to have or type "ANY"?
Your answer
Campers gather around to shell farm beans for dinner, which is more than the sharing of work – its the sharing of time spent together.
ADDITIONAL INFORMATION
Questions? 304-258-4672 wind.dance@frontier.com
Has your child attended sleep over camp(s)?
If yes, where?
Your answer
Do you have a tent that can be used during camp?
If yes, how many does the tent sleep? (please bring you tent and we will determine if it is needed)
Your answer
List other camper(s) your child would like to tent with.
Your answer
Do you give permission to use your CHILD'S NAME for articles in the Morgan Messengerand on www.facebook.com/winddancefarm and www.WindDanceFarm.org and other promotional means?
Do you give permission to use CAMP PHOTOS of your child for articles in the Morgan Messengerand on www.facebook.com/winddancefarm and www.WindDanceFarm.org and other promotional means?
Pete and Linda have been visiting camps for five years and the kids always want them to come back with their bows and arrows and new set ups. Linda & Pete are delightful at gently guiding campers in developing archery skills.
EXTRA! EXTRA! Please inform us of thoughts or concerns that may help us know your child. The more you share the greater insight we have.
Your answer
SCROLL UP AND BE SURE YOUR INFORMATION IS ACCURATE
Then move on to STEP 2
STEP 2 of 4 - DEPOSIT
MAIL a $25.00 deposit, payable to Wind Dance Farm & Earth Ed. Center. Camper's registration will be complete upon receipt of the deposit.

Wind Dance Farm and Earth Ed. Center
649 Virginia Line Road | Berkeley Springs, WV 25411

STEP 3 of 4 - PAYMENT
The deposit is not included in the camp fee(s). The remaining fee ($600 per camp + $25 administration fee) is due 2 weeks prior to camp.

one camp - $625 due
two camps - $1225 due
three camps - $1825 due
CGA $225 - Please contact Wind Dance at 304-258-4672 or wind.dance@frontier.com

Wind Dance Farm and Earth Ed. Center
649 Virginia Line Road | Berkeley Springs, WV 25411

DONATION
We work at keeping camp fees at a minimum, as well as provide high quality programs. We produce and purchase a lot of organic food. Donations, which are tax exempt, will be used to support educational programs. Make checks payable to Wind Dance Farm & Earth Ed. Center.

THANK YOU!

STEP 4 of 4 - CLICK SUBMIT!
SEE YOU THIS SUMMER!
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms