NFB CAMP PREREGISTRATION FORM
Completed form and fees must be received on or before June 15, 2002.
Parent’s Name ___________________________________________
Address _________________________________________________
City _________________________State_________ Zip __________
Phone __________________________________________________
Child(ren)’s Name(s)
____________________________ Date of Birth ____ Age ___
____________________________ Date of Birth _____ Age __
____________________________ Date of Birth_____ Age __
Include description of any disabilities/allergies we should know about :
Who, other than parents, is allowed to pick up your child?
Per
Week: $80 first child; $60 siblings, # of children ________ $_____
(Does not include banquet)
Per
Day: $20 per child per day, # days_______ x $20/child = $ ________
(Does not include banquet)
Banquet: $15 per child, # of children _____x $15 = $ _______
Total Due $ _________________
Make checks payable to and return forms to:
National Federation of the Blind of Oregon
5005 Main Street, Springfield, Oregon 97478
(541) 726-6924