On-Line Application

Chesapeake Crew Camp for Girls -- Summer 2010

On-Line Application

Welcome to our on-line application. Please begin by reading the on-line waiver -- as you fill out the form you'll be asked if you have read and agree to the waiver.

On-line Insurance and Medical Waiver

First name:
Last name:
Parent's Email address:
Address (inc. P.O. and/or Apt. #):
City:
State:
Zip code:
Phone:
Age
What is your experience level? (remember -- NO EXPERIENCE IS REQUIRED)
Experienced Camper Only -- name of school/club program:
In case of emergency during camp contact: Full Name
Emergency contact's phone number:
T-Shirt Size?
Session Requested
Payment Information	$100.00 Check or Money Order Mailed (remainder of registration fee due by July 1)
	$575.00 Full Payment Mailed
	$575.00 Full Payment Made On-Line (please return to the Payment page AFTER submiting this form to pay on-line securely through PayPal)
	$100 DepositMade On-Line (please return to the Payment page AFTER submiting this form to pay on-line securely through PayPal)
I have read and agree to sign the online waiver (parent name must be entered).
Insurance Company Name
Policy Number
Rooming request (if applicable)

Chesapeake Crew Camps, LLC