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Anchoring young men in faith, character & a spirit of service
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TEST FOR FORMS
Bill Germino
2023-05-24T10:45:53-04:00
TEST FORM
Camper Registration 2023 REVISED
Parent / Guardian Information
Name
*
First
Last
Email
*
Cell Phone
*
Home Phone
Address
*
Street Address
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
How many campers are you registering now?
*
1
2
3
Camper Information
Son's Name
*
First
Last
Hidden
Camper1-Full-Name
Grade in Fall 2023
*
5th Grade
6th Grade
7th Grade
8th Grade
School Name
*
T-Shirt Size
*
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Sports
Hobbie's / Interests
Photo of Camper (Optional)
Accepted file types: jpg, png, jpeg, gif, pdf, tiff, bmp, heif, svg, Max. file size: 5 MB.
Please provide a current photo of your son. This helps our counselors greatly (it will NOT be used for any public display). A head shot or any quality photo less than 5MB is fine. Must be in a standard picture format.
Why do you want to attend this camp?
*
Pertinent Health Information, including allergies, medications, etc.
*
Camper #2 Information
Son's Name
*
First
Last
Hidden
Camper2-Full-Name
Grade in Fall 2023
*
5th Grade
6th Grade
7th Grade
8th Grade
School Name
*
T-Shirt Size
*
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Sports
Hobbies / Other Interests
Photo of Camper
Accepted file types: jpg, png, Max. file size: 2 MB.
A head shot or any quality photo (approx. 300 x 300px) and less than 2MB is fine. Must be in JPG or PNG format.
Why do you want to attend this camp?
*
Pertinent Health Information, including allergies, medications, etc.
*
Camper #3 Information
Son's Name
*
First
Last
Hidden
Camper3-Full-Name
Grade in Fall 2023
*
5th Grade
6th Grade
7th Grade
8th Grade
School Name
*
T-Shirt Size
*
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Sports
Hobbie's / Interests
Photo of Camper
Accepted file types: jpg, png, Max. file size: 2 MB.
A head shot or any quality photo (approx. 300 x 300px) and less than 2MB is fine. Must be in JPG or PNG format.
Why do you want to attend this camp?
*
Pertinent Health Information, including allergies, medications, etc.
*
Registration Fee
Camper Fee
Camper #2 Fee
Camper #3 Fee
FEE TOTAL
Deposit Due
Price:
$0.00
Additional to pay now
To pay more than the deposit toward the total fee, enter an amount.
Scholarship Donation (optional)
For our Sebago Camp Scholarship Fund for campers in need of financial assistance
Total for Today
$0.00
Amount Due (by Check)
Price:
$0.00
Balance Due by May 22
Hidden
Total Due (Hidden)
Waivers
Medical Waiver
*
I hereby delegate authority to the Directors of the Sebago Leadership Camp (SLC) to arrange whatever medical treatment they deem necessary for him during his stay at the camp.
Photo Release
*
I hereby authorize and consent to the use and reproduction by SLC staff or an authorized agent or assignee of any and all photographs taken of my son for the purpose of promoting SLC without any compensation to me. All film, together with any prints, shall constitute property of SLC, solely and completely.
Participation and Liability Waiver
*
I hereby give permission for our son to participate in all activities conducted by SLC. We agree to hold the directors and staff harmless from any liability to anyone on account of any injuries to our son. I understand that SLC cannot be responsible for lost or broken items. I understand my son will comply with all cabin policies and procedures. I also understand, and will comply with, all cancellation policies and procedures.
Payment Method
*
Credit Card
Pay by Check
Financial Assistance
If you're in need of financial assistance with the registration fee, we offer options for a Payment Plan (pay over time) or Scholarship (reduction in amount). Please choose one below. Then, whatever amount you are able to pay now is fine. Use the Notes box as needed to elaborate on your request.
Request for Assistance
None
Scholarship
Amount You Can Pay Now
Please enter an amount you feel comfortable paying now. We will then follow up to arrange financial assistance for you.
Notes
Add any relevant notes about your request or circumstances (optional)
TOTAL for Today
$0.00
Hidden
Total - Credit Card and 0
This is a hidden value used only to set as a condition for an email notification. If the value is "0," a specific email and confirmation will be sent. The "Total" product field is not an option for email.
Hidden
Total (email trigger)
Hidden
TOTAL - Fin.Assist/PayPal Trigger
Determines if PayPal should be triggered when Financial Assistance is used. Hidden Field.
NOTE: Upon submission you will be taken to PayPal where you can pay by credit card (but it does NOT require you to have a PayPal account).
NOTE: Upon submission you will go to a page with information on paying by check, and you will receive an email confirmation with the same.
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