2011 KEYSTONE STATE CAMP APPLICATION
Please fill out this form online, click print and mail with check or money order to :
Keystone State Camps, 7 Hemlock Road, Williamsport, PA 17701
Check the camp you wish to attend :
BOYS CAMPS :
Edinboro University, June 12- June 15
 Bloomsburg University June 25- June 28
 Edinboro University, July 9- July 12
 Swarthmore College, July 14- July 17
 Slippery Rock University, July 23- July 26
Check the camp you wish to attend :
GIRLS CAMPS :
Edinboro University, June 12- June 15
 Edinboro University, June 26- June 29
Bloomsburg University, July 10- July 13
Slippery Rock University, July 27- July 30 		 
          BOY OR GIRL COMMUTER CHECK HERE (Camper not sleeping in Dorm)  
Last Name: First Name:
Address:
City:      State:    Zip Code:
Home Phone: Cell Phone
Email Address: Parent's Email: 		 
Grade in SEPT 2011: School in SEPT 2011:
Position: Height: Weight: T-Shirt Size:
Roommate Preference: (only 2 campers per room)

Parental Medical And Insurance Form - Must Be Complete To Be Accepted

I understand that Keystone State Camps  does not carry medical insurance for students, and I hereby certify that my child, ,is covered by a personal medical insurance policy that I have in force. Further, I hereby authorize routine medical dispensary care for the above-named student, and I authorize treatment not considered routine to be referred to local physicians and medical facilities at my expense.

 
Parent Name: Daytime Phone:
Address: City: State:
Zip Code: Medical Insurance Company:
Ins Policy Id #: Group #
Parent's Signature Date: / /
(Must Be Signed & Dated) 		 

Cost:                $390 if paid in full by June 1, 2011

                                    ($415 paying in full after June 1, 2011)

Commuter:        $340 if paid in full by June 1, 2011

                                    ($365 paying in full after June 1, 2011)

PERSONAL CHECKS WILL NOT BE ACCEPTED AFTER JUNE 1. Only money orders, cashier's checks or certified checks will be accepted after JUNE 1. A Confirmation & Directions will be mailed in approximately two weeks.

Make check or money order payable to: Keystone State Camps.
Be sure to SIGN the application.

Mail to: Keystone State Camps, 7 Hemlock Road, Williamsport, PA 17701


  


APPLICATION CHECKLIST

1. Did you select the location and date you will attend?

2. Did you mark the position you play?

3. Did you fill in your height, weight and grade in school in September of 2011?

4. Is the insurance information completed and signed by the parent or guardian?

5. Be sure to enclose your $75 DEPOSIT OR FULL PAYMENT and to sign your check!
Payment: To make a reservation, send at least a $75 non-refundable deposit or full payment with your completed application.