John Muir Mountain Day Camp
	Home Photo Gallery Flyer (PDF) About Us Contact Us

Sign me Up for the John Muir Mountain Day Camp!

2009 Registration Form

(Please Print this page out, and fill it out clearly)

Choose which session you would like to attend:

___ Session 1:  July 27 – July 31, 2009 Session 1 and Session 3 are identical
___ Sesson 2:  August 3 – August 7, 2009
         (Session 2 will be different if you want your child to attend a 2 week camp.)
___ Session 3:  August 10 – August 14, 2009

Student Name: ______________________________________________________

Student Age in August, 2009: ___________________________________________

Student Grade in 2009-2010 School Year: __________________________________

Circle T-shirt Size in Summer of 2009:
YOUTH:  S 6-8   M 10-12   L 14-16   XL 18-20
ADULT:  S  M  L  XL

Parent/Guardian: _____________________________________________________

Home phone: ________________     Cell phone: ________________

Work phone:_________________

E-mail Address: ___________________________________________

Address: ________________________________________________

City ________________________________________State _______

Method of payment (circle):    Cash    Check    AmEX    Visa    MC   Discover

Card Number: ________________________________________________________

Expiration Date: __________________

Amount:

$200.00 for JMA members before January 1, 2009
$225.00 before January 1, 2009

$225.00 for JMA members on or after January 1, 2009
$250.00 on or after January 1, 2009
$25.00 discount for each additional child from the same family
$25.00 discount for registering for a second week

Signature: ________________________________________________________

Mail form and Fees to:

Make checks payable to: Willows Theatre Box Office
Attn: John Muir Mountain Day Camp
636 Ward Street
Martinez, CA 94553

Fax: (925) 957-2504

Questions? Call Camp Director Jill Harcke : (925) 676-6925
E-Mail: harcke@comcast.net
Web: www.muircamp.org