Summer 2010 Web Form Ages 9 and Up

Please fill out the form below...To avoid as much registration frustration as we can, we've decided to use an online request form that will place everyone on a waitlist. The form will come to us with a time stamp which we'll review in the order in which it was received. It is important that you tell us on this form how many camps you would like to participate in, as well as all the sessions for which you are available. This will increase the chance of getting your child placed in a camp this summer.

Your Name
Your Email Address
Your Child's Name
Child's Date of Birth
Child's Age
Best Contact Phone Number
Programs you'd like to attend (please list ALL possible sessions so we can best match you with openings)	Session 2 (June 14-25): 2 Week Dragonfly, Ages 9-12 Session 2 (June 14-25): 2 Week Ringtail, Ages 11-14 Session 4 (July 5-9): 1 Week Peacemakers Journey, Ages 9-12 Session 5 (July 12-23): 2 Week Dragonfly, Ages 9-12 Session 5 (July 12-23): 2 Week Ringtail, Ages 11-14 Session 6 (July 26-30): 1 Week Raven-Four Fires, Teen Expedition, Ages 13-17 Session 7 (August 2-13): 2 Week Dragonfly, Ages 9-12 Session 7 (August 9-13): 1 Week Phoebes, Teen Women Expedition, 8th-10th Grade
How did you hear about us?
Would you like to be added to our email list?	Yes
Additional Comments
What is your child's gender	Girl Boy Transgender/Other
How many total sessions do you want?
Please choose a payment tier (Choose the highest tier you can afford. Tier C represents the actual cost to WYP). Scholarships below Tier A are available upon request.	Dragonfly Tier A (two week): $475 Dragonfly Tier B (two week): $575 Dragonfly Tier C (two week): $675 Ringtail Tier A (two week): $675 Ringtail Tier B (two week): $775 Ringtail Tier C (two week): $850 Phoebes Tier A : $500 Phoebes Tier B : $550 Phoebes Tier C : $600 I need additional financial assistance below Tier A
If you need financial assistance below Tier A, please write in the amount you can afford here.
Image Verification Please enter the text from the image: [ Refresh Image ] [ What's This? ]