UAF RECREATIONAL CAMP SUMMER 2009

DATES
AM
Session
PM
Session
All
Day
Before
Care
After
Care
Daily Care:
Before or After
Total
Week 1 July 6-10
$100
$100
$200
$20
$20
$5
$________
Week 2 July 13-17
$100
$100
$200
$20
$20
$5
$________
Week 3 July 20-24
$100
$100
$200
$20
$20
$5
$________
Week 4 July 27-31
$100
$100
$200
$20
$20
$5
$________
Week 5 August 3-7
$100
$100
$200
$20
$20
$5
$________
Week 6 August 10-14
$100
$100
$200
$20
$20
$5
$________

Camper's Name: __________________________________________ Phone:__________________

Address: _______________________________________________________________________

City/State: ___________________________________________ Zip Code: __________________

T-SHIRT SIZE: YOUTH: (6-8) (10-12) (14-16)      Adult : SMALL     MEDIUM    LARGE     XL  2XL

Grade entering in Fall 2009: ______________Age: ________   School: _________________________

Emergency contact:________________________________________Phone:____________________

Insurance coverage by:___________________________Policy number: ________________________

Payment Method:  Cash        Check         Visa         MC

Account#:_____________________________________ Exp. Date _________________ V Code _____

Please charge a $50 deposit for each week ______ Please charge as paid in full at this time _____

Name appearing on card:___________________________________________________________

Signature of cardholder: ____________________________________________________________

PRINT FORM, COMPLETE, AND MAIL or FAX (907-474-1998) WITH PAYMENT TO:
UAF Recreational Camp
University of Alaska Fairbanks
P.O. Box 757440
Fairbanks, AK 99775-7440

Ruth Olsen
(907) 474-6814
ruth.olsen@uaf.edu