REGISTRATION

Blue Mountain Summer Camps 2006

Rec'd ___/___/06

Check#

Amount _______

Date_________, 2006

Please make two selections per week-order indicates first and second choice.

We will confirm your registration by May, 25th.

1st choice 2nd choice

Session #/Dates Workshop/camp Workshop/Camp FEE

~Session #1 6/19-6/22

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~Session# 2 6/26-6/29

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~Session #3 7/3-7/6

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~Session #4 7/10-7/13

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~Session #5 7/17-7/20

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~Session #6 7/24-7/27

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~Session #7 7/30-8/3

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~Session #8 8/7-8/10

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Camper's name______________________________________________________________________

Birthdate:____/____/_____ Age_______ Gender: M______ F______

Parent/Guardian_________________ Street/City/State_______________________________________

Home Phone______________Work Phone_________________Cell_______________Email__________

BMS student? Y_____N_____

Mail form to: Blue Mountain School, Summer Camps.470 Christiansburg Pike,N.E,

Floyd , VA.24091-3737

540-745-4234 or Email bms@swva.net