Goldpetals Nature Camp Application 2014

 Name:

Age:

Mailing Address:

Email Address:

Phone Numbers

Emergency Contact number:

 

Allergies? Medications?

Likes and Dislikes:

Able swimmer?

Parents signature:

 

Please send to:

Ellen White Weir

111 Christian Hill Road

Cooperstown, NY 13326

607-547-8425