Reg. Form: Santa Rosa Peace Camp August 6-10, 2012 cost $170.
Please send this form with a $50 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. Partial scholarships are available until June 1. Questions? Email Mary, our director, marymiche@JPS.net or leave a message on our phone (510)845-8417
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
Please apply between April 1 and June 1. No scholarships given 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 $50 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.
