CAMP JUST IMAGINE
GEORGETOWN HIGH SCHOOL
June 9-13, 2008

8:30 am - 5:00 pm

$135 Per Camper
(registration includes daily, healthy snacks and a camp t-shirt)

Camper Information

* First Name

* Last Name

* Gender

* Birth Date

* Student's Campus in Fall '08

* Grade Level

Household / Adult Primary Contact

* Relationship to Participant:

Mother

Father

Guardian

Other

* First Name

* Last Name

* Address 1

Address 2

* City

* State

* Zip

Daytime Phone

Evening Phone

* Email Address

Emergency Contact Information

* Emergency Contact

* Emergency Contact Phone

* Medical Insurance Company

* Insurance ID # / Group #

* Insurance Phone

* Insured Name

* Insured Address

* Insured Phone

* Primary Care Physician

* Physician Phone Number

Download Camp Just Imagine Medical Release Form

Download Camp Just Imagine General Liability Form

Medical release and general liability forms will be required for each camper.

Terms and Conditions

Availability is limited. Registration fee includes snacks and T-shirt. $75 of the registration fee is non-refundable. Refunds are available up to three weeks prior to the start date of the camp. Submission of this application to the Texas Congress of Parents and Teachers confirms your knowledge and acceptance of these conditions.

Payment Information

* Method of Payment:

Please use credit card info below

* Cardholder Name

* Credit Card

* Card Number

* Expiration

* CV Code

* Indicates Response Required