Marcellus Summer Camp

Residential Fee:


Commuter Fee:


Registration Deadline:

July 5, 2013

A nonrefundable deposit of $75.00 is required at the time of registration

*If you wish to pay by check, please fill in the mail-in form.

Camper's Information

* Indicates a required field

*First Name: *Last Name:

*Gender: Male Female      *Age:      *T Shirt Size:

*Camper Status: Resident Commuter

Roommate Request: (Request must be made by both campers)

School:      Grade in Current School Year:    High School Graduation Year:


Parent/Card Holder Information:

*Parent Name:

*Street Address:

*City: *State: *Zip Code:


Home Phone:

Work Phone: Whose work number?: