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