Summer Camp Registration – Part I - Ebersole Summer Camp Overview - Ebersole Environmental Education and Conference Center - Departments

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Ready to make BIG DREAMS come true?

DIRECTIONS: Summer camp registration is a 2-part process which starts with the submission of - Part I - this short registration form. Please provide responses to all REQUIRED and RELEVANT fields. Upon submitting Part I you will receive an email prompting you to complete a longer - Part II - health history form (required by law from the State of Michigan).

Note that in order to reserve a space for your camper Parts I & II must be completed. Should you have any questions or concerns about the 2-part summer camp registration process please do not hesitate to contact us at 517-755-5000.

With gratitude and appreciation, Ben Botwinski (Ebersole Director)

Ebersole Summer Camp Registration - Part I

PART I - SECTION A: CAMP(S) SELECTION

Please select the overnight camp(s) that you would like your camper to attend: (required) Crime Scene Investigation (CSI); Grades 4-6; June 17 to June 20 Junior Counselor Orientation I; Grades 9-12; July 8 to July 9 Movin' and Groovin' I (MGI); Grades 4-6; July 9 to July 12 Adventurers Weekend (must be in MGI and MGII); Grades 4-6; July 12 to July 14 Movin' and Groovin' II (MGII); Grades 4-6; July 15 to July 18 Band Camp (Everett High School); July 21 to July 26 Junior Counselor Orientation II; Grades 7-8; July 28 to July 29 Words, Woods, and Water; Grades K-3; July 29 to August 1 Band Camp (Eastern High School); August 4 to August 9 Band and Choir Camp (Sexton High School); August 12 to August 16

PART I - SECTION B: CAMPER'S INFORMATION

Camper's Last Name:

Camper's First Name:

Camper's Middle Name/Initial:

Camper's Date of Birth (MM/DD/YYYY):

Camper's Gender:

Camper's School (for 2018-2019):

Camper's Grade Level (for 2018-2019):

Camper's Street Address:

Camper's City of Residence:

Camper's State of Residence:

Camper's Zip Code:

PART I - SECTION C: PARENT/GUARDIAN'S INFORMATION

Parent/Guardian's Last Name:

Parent/Guardian's First Name:

Relationship to the Camper:

Parent/Guardian's Primary Phone:

Parent/Guardians Secondary Phone:

Parent/Guardian's Email Address:

Is the parent/guardian's mailing address the same as the camper's?

If NO, please provide parent/guardian's mailing address in the fields below.

Parent/Guardian's Street Address

Parent/Guardian's City of Residence:

Parent/Guardian's State of Residence:

Parent/Guardian's Zip Code:

PART I - SECTION D: CAMP CHAPERONE

Is an adult from this camper's family interested in chaperoning at camp?

Note that selecting YES, to the question above does not guarantee a spot as a chaperone. Chaperone space is limited and all chaperones must undergo a background check. Thank you in advance for your interest and understanding.

Ebersole Center

3400 2nd Street

Wayland, MI 49348

517-755-5000

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