Camp registration form

SESSION 1
JULY 7-11:
Native Americans and how they lived.

SESSION 2
JULY 14-18:
Waterways of New York, and their inhabitants.

SESSION 3
July 21-25:
Explorers - Study them and then become one.

SESSION 4
July 28 - August 1
The ancient forests of New York.

SESSION 5
AUG 4-8
How the first settlers survived.

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The
Greenbelt
Conservancy
Summer
Day Camp
program is
for children
ages 5-12.

5-year-olds
must turn 6
by Dec. 31,
2008.

QUESTIONS?
Call
1-718-667-2165
or e-mail us.

The Greenbelt Conservancy Summer Day Camp

Registrations for the Greenbelt Conservancy Summer Day Camp program
are accepted only by mail on a first-come, first-served basis.
The fee for each week-long session is $110 for Conservancy members
and $125 for non-members. Each camper will receive a free T-shirt!
Extra T-shirts are available for $5 each.

Camp headquarters is High Rock Park, 200 Nevada Avenue, off Rockland Avenue.
Camp hours are 9:30 a.m. - 12:30 p.m. Monday through Friday.

Please print this page and fill out the form below.
Mail the completed form, with your check or money order, to:
The Greenbelt Conservancy
Summer Day Camp
200 Nevada Avenue
Staten Island NY 10306

Summer Day Camp is for youngsters ages 5-12. For younger children, see our Mini Camp program.
Please print clearly

CHILD'S NAME	RETURNING CAMPER?	DATE OF BIRTH	SESSION NUMBER	FEE
Jane Q. Example	Yes	4-8-99	1,2	$220

TOTAL AMOUNT ENCLOSED $________________________

PARENT'S NAME:_______________________________________________________

ADDRESS:____________________________________________________________

CITY:__________________________________ STATE:_____ ZIP:_________________

DAYTIME TELEPHONE NUMBER:__________________________________________

E-MAIL ADDRESS:_____________________________________________________

List special group requests (cannot be guaranteed)

____________________________________________________________________

Attach copy of birth certificate (Ages 5-7 only). Make checks and money orders payable to
The Greenbelt Conservancy. Please do not send cash.

The Greenbelt Conservancy and NYC Parks and Recreation have my permission to use photos/video recordings of my child for promotional purposes.

SIGNATURE:____________________________________________DATE_______________