Registration & Information : Mount Pisgah Arboretum

Outdoor Adventure Camp 2012

Please fill out the information below. Upon completion, you will be sent to a PayPal screen to pay a deposit of $25 per camper per session. A bill with the remaining balance will promptly be mailed to you.

How many campers will you be registering?
Camper 1 Name*
FirstLast
Camper 1 Birthdate*
MM
DD
YYYY
Camper 1 Age*
Camper 1 Sex?*
Camper 2 Name*
FirstLast
Camper 2 Birthdate*
MM
DD
YYYY
Camper 2 Age*
Camper 2 Sex?*
Camper 3 Name*
FirstLast
Camper 3 Birthdate*
MM
DD
YYYY
Camper 3 Age*
Camper 2 Sex?*
Person 1, Parent or Guardian?*
Name of Parent or Guardian 1*
FirstLast
Parent/Guardian 1 Address*
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
Parent/Guardian 1 Day Phone Number*
Parent/Guardian 1 Evening Phone Number
Parent/Guardian 1 Cell Phone Number*
Parent/Guardian 1 Email Address*
For updates and important information regarding camp.
Person 2, Parent or Guardian?
Name of Parent or Guardian 2
FirstLast
Parent/Guardian 2 Address
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
Parent/Guardian 2 Day Phone Number
Parent/Guardian 2 Evening Phone Number
Parent/Guardian 2 Cell Phone Number
Parent/Guardian 2 Email Address
For updates and important information regarding camp.
Are you a Mount Pisgah Arboretum Member? *
- Yes
- No
Discount fee rates for MPA Members with a Family membership or greater. (If you need to renew your membership for camp, please click 'no'.)
Would you like to become a member?
Mount Pisgah Summer Camp fees are $190 per week for members and $230 for non-members. A Mount Pisgah Arboretum membership also includes a 2012-2013 parking pass and tickets for your family to our Mushroom and Wildflower Festival. (Non-members have to pay a $3/day parking pass fee to Lane County Parks to park and pick up their campers.)

Mount Pisgah Arboretum Family Membership costs $50.00.
Yes! I'd like to become a member.
Price: $50.00 Quantity:

Permission for Picture Taking
My child/children may have his/her picture taken and used for Arboretum publicity or news purposes.
Picture Taking Permission*
- Yes, you may photograph.
- No, you may not photograph.
How did you hear about Mount Pisgah Summer Camp?*
IMPORTANT-
By clicking submit you will be taken to a PayPal screen to pay the $25 deposit per camper per session. All additional forms (such as medical forms and release permission forms) will be sent to you after you have paid the deposit.

Mount Pisgah Arboretum

Registration & Information

Outdoor Adventure Camp 2012

Step 1 of 3 - General Information

Would you like to become a member?

Which week(s) of camp will Camper 1 attend?

Which week(s) of camp will Camper 2 attend?

Which week(s) of camp will Camper 3 attend?

Permission for Picture Taking

IMPORTANT-

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