Camper Registration Form – Kako Retreat Center

Camper's Name(required)

Gender(required)

Male

Female

Age(required)

Date of Birth(required)

Weight (lbs)(required)

Camp Attending(required)

Elementary Camp #1 June 12-16

Junior High Camp #1 June 19-23

Junior High Camp #2 June 26-30

Elementary Camp #2 July 3-7

Teen Camp July 10-14

Junior High Camp #3 July 17-21

Contact Info

Village/Town where camper lives(required)

Village/Town where camper wants to be picked up(required)

Parent/Guardian/Emergency Contact Name(required)

Parent/Guardian/Emergency Contact Email(required)

Home/Cell Phone(required)

Camper Cell Phone (If they have one)

Mailing Address(required)

Include Zip Code

Secondary Contact Person

Secondary Contact Name

Secondary Contact Phone

Payment

Payment - $150 per camper(required)

Sending cash/check

Credit/Debit Card

Please call me to make Credit/Debit Card payment

Please call Kako (907) 584-5200 if you want your children to come but can't afford to make partial or full payment.

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