Canby Grove

Parent Name * First Last
The person filling out this form
Home Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Home Phone * ### - ### - ####
Parent Email *
Camper #1 Name * First Last
Or Spouse if attending Family Camp
Gender *
Male Female
Grade (Fall 10) *
Camper #2 Name First Last
Gender
Male Female
Grade (Fall 10)
Camper #3 Name First Last
Gender
Male Female
Grade (Fall 10)
Have you been to camp at Canby Grove before?
Yes No
How did you hear about Canby Grove? *
If you selected other, how did you hear about Canby Grove?
Which camp(s) would you like to attend? *
Day Camp 1 June 21-25 Day Camp 2/Plus June 28-July 2 Juniors Camp 1 July 5-9 Family Camp July 11-16 Adventure Camp Quest July 18-23 Day Camp 3 July 26-30 Juniors Camp 2 August 2-6 Day Camp 4 August 9-13 Adventure Camp Summit(s)

Please check more than one box if you have campers going to different camps
If you are attending Family Camp, how many family members (adults and children) are attending? What genders & ages (if not listed above) are the children?
If you are attending Family Camp, what housing accommodations are you interested in?

Sorry, no scholarships available for Riverfront Lodge
Please check any boxes that apply to your financial condition necessitating your request for scholarship funds: *
Job Loss Unexpected Large Bills Other
If you checked Other, or would like to give more information, please do so below.
How much scholarship funds are needed to make it possible to send your family/child(ren) to camp? * $ Dollars . Cents
Do Not Fill This Out

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