Sea Camp Registration

Registration Instructions

1. Determine the camp in which you are interested and write down the Call #.
2. Have ready all personal information listed below and call Lynette DeBerry at (757) 683-4247.
3. Have payment information ready.  You will have the option of providing this over the phone, faxing the form below, or mailing the information (if paying by check).  Please understand that camper is not enrolled until payment is processed.

DATES

Camp Type

Call #

Term

WK1: June 22-26

Jr. Camp 6-8

90064

200845

WK1: June 22-26

Jr. Camp 6-8

90065

200845

WK1: June 22-26

Sr. Camp 9-12

90066

200845

WK2: July 6-10

Jr. Camp 6-8

90004

200915

WK2: July 6-10

Sr. Camp 9-12

90014

200915

WK2: July 6-10

Sr. Camp 9-12

90015

200915

WK3:July 13-17

Jr. Camp 6-8

90005

200915

WK3:July 13-17

Sr. Camp 9-12

90016

200915

WK3:July 13-17

Teen Camp 13-17

90012

200915

WK4: July 20-24

Jr. Camp 6-8

90006

200915

WK4: July 20-24

Jr. Camp 6-8

90007

200915

WK4: July 20-24

Sr. Camp 9-12

90017

200915

WK5: July 27-31

Jr. Camp 6-8

90008

200915

WK5: July 27-31

Sr. Camp 9-12

90018

200915

WK5: July 27-31

Sr. Camp 9-12

90019

200915

WK6: August 3-7

Jr. Camp 6-8

90009

200915

WK6: August 3-7

Sr. Camp 9-12

90020

200915

WK6: August 3-7

Teen Camp 13-17

90013

200915

WK7: August 10-14

Jr. Camp 6-8

90010

200915

WK7: August 10-14

Jr. Camp 6-8

90011

200915

WK7: August 10-14

Sr. Camp 9-12

90021

200915

Child's Name:______________________________________

Birth Date (M/D/Y)_________________Gender:___________Age:____

Address:__________________________________________________

City:____________________________State:_____________Zip:____________

CHILD MUST be registered in the proper age group. No exceptions.

Parent/Guardian Name:________________________________

Day Phone:______________________

Evening Phone:______________________

Email address:_______________________________________________

Please check the appropriate line based on the number of children you are registering.

____I authorize the amount of $225 to be charged to my:

____I authorize the amount of $213.75 to be charged to my:

There is a 5% discount for siblings who register together

Please include your 3 digit Security code  and billing zip code for credit card authorization.

Visa     Mastercard     Check

Card No.____________________________________Exp. Date:____________

_____________

Exp. Date:___________

Security code:_________

Billing zip Code_______________

Authorizing signature:_______________________________________________