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