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Campers // Register Online

PLEASE NOTE:  To register online, please use the camper application below.  The application must be submitted by the parent or legal guardian.

Your application is not complete until we have received a $350* registration fee per session for each child.  This fee is applied to the total charge for camp when full payment comes due on May 1.  The registration fee is non-refundable.  You will receive notice of your balance due.

Acceptance is not official until confirmation is received from the camp office.

BILLING AND PAYMENT PLANS
Registration fees are payable via Check, MasterCard, or Visa. Payment by check should be made payable to Surprise Lake Camp.

To charge to a credit card fill in the form at the bottom of the page.

Payment Schedule:  50% due by January 15 and full payment by May 1, 2008. For more information on fees go to the Camp Fees page.

Please fill out the form completely.  If you have any questions please contact us.

PERMIT REQUIREMENTS: CAMP IS REQUIRED TO BE INSPECTED TWICE YEARLY. WE OPERATE WITH A PERMIT GRANTED BY THE PUTNAM COUNTY HEALTH DEPARTMENT. INSPECTION REPORTS ARE AT THE PUTNAM COUNTY BUILDING, CARMEL, NEW YORK 10512.

 
CAMPER REGISTRATION FORM
* Last Name of Camper(s):
* Address:
* City:
* State:
* Zip:
* Home Phone:
Fax:
* Parent Email:
* Do you prefer to receive correspondence/forms from camp by Email?
  
* Child # 1 First Name:
* Gender:
* Birthdate:
* Age as of 6/30/08:
* Grade as of 9/07:
* Session:
* Camper status:
Child # 2 First Name:
Gender:
Birthdate:
Age as of 6/30/08:
Grade as of 9/07:
Session:
Camper status:
Child # 3 First Name:
Gender:
Birthdate:
Age as of 6/30/08:
Grade as of 9/07:
Session:
Camper status:
Parent 1's Full Name:
Parent 1's Business Phone:
Parent 1's Cell Phone:
Parent 1's Occupation:
Parent 1's Work Hours:
Parent 2's Full Name:
Parent 2's Business Phone:
Parent 2's Cell Phone:
Parent 2's Occupation:
Parent 2's Work Hours:
IN AN EMERGENCY, CONTACT:
Name (other than parent/guardian):
Relationship to Camper:
Phone:
RESIDENCE OF CAMPER(S):
Bronx Brooklyn Manhattan Queens
Staten Island New Jersey Nassau Suffolk
Westchester Connecticut Rockland Orange
Putnam Dutchess Florida Other
Marital Status of Parent or Guardian with Whom Camper(s) Reside:
Married Separated Divorced
Widowed Remarried Single
Are you a member of a "Y", Jewish
Comminity Center, or Synagogue?
If YES, Name:
How did you hear of Suprise Lake Camp?
FOR 15 YEAR OLDS ONLY: Is your child interested in Work Program?
Name of Medical Insurer:
Policy #:
Please assign transportation as follows:
CREDIT CARD INFORMATION
* Credit Card :
* Cardholder Name:
* Card Number:
* Expiration Date (mm/yy):
 

 
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