Camper Info

NOTE: Required fields are indicated with an *

How did you learn about us? --None-- Referral by EV Referral by teacher Referral - other EV Service EV Website Web/Online Search Posting Tabling Special Event - EV Special Event - Other Public Relations Mailing List Email Phone Print Radio TV Cold Call Partner Word of Mouth Other Current Donor
First Name*:
Last Name*:
Grade (entering Fall '08)*: --None-- 1 2 3 4 5
Gender*: --None-- Male Female
Birthday (enter as mm/dd/yy)*:
T-Shirt Size*: --None--Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large
Camper lives with*: --None-- Parent 1 Parent 2

Parent/Guardian Contact Info:

Parent 1 Information

Parent 1 First Name*:
Parent 1 Last Name*:
Parent 1 Relation to Camper*: --None-- Mother Father Other
Day Phone (P1)*:
Cell Phone (P1):
Eve Phone (P1):
Email (P1)*:
Address (P1)*:
City (P1)*:
Zip (P1)*:

Parent 2 Information
(Required if camper is living with Parent 2)

Parent 2 First Name:
Parent 2 Last Name:
Parent 2 Relation to Camper: --None-- Mother Father Other
Day Phone (P2):
Cell Phone (P2):
Eve Phone (P2):
Email (P2):
Address (P2):
City (P2):
Zip (P2):

Additional Emergency Contact:

Emergency Contact First Name:
Emergency Contact Last Name:
Day Phone (EC):
Cell Phone (EC):
Email (EC):
Relationship to Camper: --None--Guardian Grandparent Aunt/Uncle Friend/Neighbor Au Pair Other

Session Info: June 23-27 & July 7-11 

Program hours: Mon. - Fri., 9 AM-4 PM

Tuition is $330/week (Registration before April 15th: $310/week)

Extended Day (8-9 AM & 4-5 PM on camp days) Additional $40 per session

Session Info: Day Trippers, June 30-July 3 

Program hours: Mon. - Thurs., 9 AM-4 PM

Tuition is $110/day  or $400/session

Extended Day (8-9 AM & 4-5 PM on camp days) Additional $10 per day

Fees  

A minimum $75 deposit is required for each session requested. (A reservation will be held for one week from the date of the submission of this online application pending receipt of your deposit.)

SNAKE Camp sessions @ $330 each

Extended Day sessions @ $370 each

SNAKE Early Reg Discount (-$20/session before 4/15)

Day Tripper Days @ $110 each

Extended Day Tripper Days @ $120 each

Day Tripper Full Session Discount (-$40/camper)

Total Tuition:

See payment information in right hand column above.

Scholarships

A limited number of need-based scholarships are available. Please complete the entire registration form, including the tuition section, even if you are applying for a scholarship.

Request a scholarship: Yes

Click here to download the scholarship form.

Discrimination Policy

S.N.A.K.E. Camp is available to all without regard to race, color, national origin, sex or disability.

Submit

Please print a copy of your registration for your records BEFORE submitting. You will not automatically receive a copy of your submission. Make sure you have completed ALL REQUIRED FIELDS. Thank you.