Reg. Form: Peace Camp, July 16-20, 2012 cost $75 per week
Please send this form with a $25 non-refundable deposit per child.  Make the check payable to Peace Camp. Send it to: Peace Camp, P.O. Box 448, Lakeport, CA 95453. We go by the postmark to determine priority. Balance is due two weeks before camp begins.   Scholarships available until June 1.
Questions?  Email Mary, our director, at marymiche[at] JPS.net or call (510) 845-8417 to leave a message.

Child’s Name _________________________________________________Age (when camp starts)______

Parents’ Names _________________________________________________________________________

Phone Numbers (H) ____________________(W)_____________________ (Extra)___________________

Address of child ________________________________________________________________________

      City _________________________________________________ Zip Code _______________

Parent Signature __________________________________________________________ Date__________

parent email_____________________________________________________________________________

How did you hear about us?_______________________________________________________________
Click below to return to Peace Camp Website
About Scholarships:
Scholarships are available from April 1 until June 1. No scholarships after June 1.
If you would like to apply for a scholarship, you will need to send us
your Tax form 1040 from 2010, a deposit of $25 and the registration form (above).
Scholarships are given out on a first come first served basis.
We use the postmark on your envelope to decide who applied first.