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Enrollment Form - Page 1 of 3

Customer Information (Limit of one camper per form please).
Camper's First Name*:
Camper's Last Name*:
Gender*:
Camp*: Camp Chipinaw @ Silver Lake
Parent/Guardian*:
Street Address*:
Apt #:
City*:
State*:
Zip Code*:
Home Phone*:
Cell Phone:
Email*:
Return address if different:
 
Directions to Your Residence
If you know your address is not found by computer mapping programs, for example MapQuest, please provide directions from the nearest main road or cross street. Include detailed directions if necessary.
We are located off of:
between:
and:
Detailed Directions:
 
Special Arrangements at Your Home
If nobody is home, pick up bags from:


If other:

If nobody is home, return bags to the:


If other:

If you selected Doorman, list the hours the doorman is on duty (ex: 24 hours, 7am-5pm):