La Vida Center for Outdoor Education & Leadership
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Adventure Camp Registration

A nonrefundable $100 deposit is required for each week of camp, however online payment is not possible at this time. If you are applying online, the deposit must be received within 5 business days of application submission. Make checks payable to "Gordon College" (we can no longer accept checks made out to "La Vida Adventure Camp"—they will be returned). Please include your child’s name and "La Vida" on the memo line, and mail checks to the La Vida Center, 255 Grapevine Road, Wenham, MA 01984. Payment can also be made by credit card (Visa or Mastercard) by calling the La Vida office at 978.867.4111. La Vida will contact you to confirm your camp enrollment after we have received your application and deposit.

Please Note: This form will timeout and erase answers after 20 minutes.


2014 La Vida Adventure Camp Registration

1. Select Adventure Camp dates:

June 23-27
June 30-July 3
July 7-11
July 14-18
July 21-25
July 28-August 1
August 4-8

2. Select program option:

11-13
14-15 On Campus (overnight camping in Gordon woods, climbing on real rock)
14-15 Off Campus (overnight camp and hike in NH, canoe on Ipswich River, climbing on real rock)

3. T-shirt size

4. Camper first name

5. Camper last name

6. Parent/guardian name (First, Last)

7. Address

8. City

9. State

10. Zip code

11. Home phone number

12. Cell phone number

13. Work phone number

14. Email address

15. Sex

Male
Female

16. Date of birth (mm/dd/yyyy)

17. Age at date of camp (Campers must be age 11 by 8/31/14.)

18. Current grade level

19. List any siblings that are signing up for camp to receive a sibling discount:

20. Health problems we should know about:

21. Allergies (especially food or bee sting allergies):

22. How did you hear about us?

Mailing
Camp fair
Attended camp before
Friend or family
Web
Other

23. A $100 non-refundable deposit for each week of camp is due within 5 days of applying for the La Vida Adventure Camp. Please indicate which type of payment you will be using for the deposit.

I will be sending in a check to the La Vida office.
I will be calling the La Vida office to pay the deposit by credit card (Visa or Mastercard)