Back to Previous Page

History Lives Here Text

Root Camp LogoCamper Registration

Please note:  If attending on a scholarship, please do not register online. Our scholarship guidelines have changed for 2016. Please contact Ruth Johnson if you are interested to learn about a scholarship to attend Root Camp and the requirements.

It's necessary to complete and submit a separate registration form for each child.

Camp Dates - June 26-29 2017

Session: Sold Out     
Registering: (First or Only Camper) (Additional Camper)
   
Camper's Name:  
Date of Birth: Age:
Gender:    
T-shirt size Youth        Adult      
Address  
City State Zip Code
       
E-mail Address  
Phone Number    
       
Parent/Guardian Name(s):    
Contact Information (if different from above):    
Name and contact of person picking camper up:    
Names of people NOT allowed to pick up camper (if any)  
       
Medical Information      
Insurance Company: Policy/Group Number:
Emergency Contact Name: Emergency Contact Phone:
       
The following snacks will be provided: Local Seasonal Fruit and Vegetables, Trail Mix (NO NUTS), Wheat Crackers and Cheese, Beef Jerky.
Please Advise of ANY food or Environmental allergies below:
 
Does your child have a bee allergy? Yes    
Additional Comments
     

When submitted, your registration is passed on to the SDHS and you are forwarded to PayPal to pay the registration fee. If you have additional campers to register, click on PayPal's Continue Shopping button and you'll be returned to this page.

It is NOT necessary to have a PayPal account. The PayPal shopping cart has an option to pay by credit card without using a PayPal account.