Summer Family Camp Registration: July 7-9, 2017
Please complete the following form to register your family for our Summer Family Camp, July 7-9, 2017 at Birchwood Camp. Be sure to list all the family members attending with you below.

If you have questions or problems with this registration form please call 688-2734 or email info@birchwoodcamp.org.

Name
You will be the primary registrant for your family
Your answer
Date of Birth
Your answer
Address
Your answer
City, State, Zip
Your answer
Email
Your answer
Phone
Your answer
Church (if any)
Your answer
Name, Age, Relationship to Registrant
Please list the name, age, and gender of each family member attending with you.
Your answer
Accommodation. Are you willing to share a cabin with another family, and if so, whom?
Your answer
Special Health Needs
Special Dietary Needs for your Family
When communicated in advance, we generally can provide menu items that will accommodate special diets. It is very important to indicate any food allergies. Please give us specifics in the space provided in the "other" section below.
Required
Do you have any other medical or health concerns in your family we should be aware of?
These will be kept confidential.
Your answer
Emergency Contact
Your answer
Payment Information
Registration fees: $100 per adult, $60 per child/teen (under 18), free for babies & toddlers under 4.

There is a $25 late fee per family for registrations received after June 23.

A $25 non-refundable deposit is required per family. Cancellations before June 23 will receive a 50% refund. Cancellations within 14 days of family camp will receive no refund.

Please select the appropriate fees for your family:
Check a box for each person attending.
Required
Total Registration Fee:
Your answer
How will you be paying for this Family Camp registration?
Credit cards are accepted on our website: www.birchwoodcamp.org; use the "make a payment" function on the left side. Checks can be mailed to PO Box 670049 Chugiak, AK 99567.
By submitting this form I agree to the following for myself and all members of my family attending:
I recognize and acknowledge that camp activities can involve certain hazards, including, but not limited to illness, injury and accidents, and I hereby release Birchwood Camp and the Alaska United Methodist Conference from all liability.

I give permission for
-Photos/video to be used in future publicity
-Participant's name, address and email address to be shared with other registered participants and staff.

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