REGISTRATION FORM

Please send to:

Extreme Adventures of Vermont

PO Box 1035 Chester, VT 05143 USA

Yes, I would like to reserve a spot for my child (children) at Vermont Adventure Camps at EAVT.

Parent’s Name: ______________________________________

Child’s Name: _______________________________________

Child’s Age: ________

Address: ______________________________________

City: ________________________________

State: ____________________

Zip: _____________________

Phone: (_____)________________

How did you hear about us?:________________________

Circle the camp(s) that you are signing your child up for.

Six Day Water Adventure Camp (age 11 & 12) June 20th- June 26th $850

Six Day Intro to Climbing and Rappeling Camp (age 11 & 12) June 27th- July 3th $850

Six Day Multi Sport Adventure Camp (age 11 & 12) July 4th- July 10th $850

Six Day Water Adventure Camps (age 11 & 12) July 11th- July 17th $850

Six Day Intro to Climbing and Rappeling Camp (age 11 & 12) July 18th- July 24th $850

Six Day Multi Sport Adventure Camp (age 11 & 12) July 25th- July 31st $850

Six Day Intro to Climbing and Rappeling Camp (age 11 & 12) August 1nd- Aug 7th $850

Six Day Water Adventure Camps (age 11 & 12) August 8th- August 14th $850

Six Day Water Adventure Camp (age 13-14) June 20th- June 26th $900

Six Day Climb & Cave & Canyoneer Camp (age 13-14) June 27th- July 3th $900

Six Day Multi Sport Adventure Camp (age 13-14) July 4th- July 10th $900

Six Day Water Adventure Camps (age 13-14) July 11th- July 17th $900

Six Day Climb & Cave & Canyoneer Camp (age 13-14) July 18th- July 24th $900

Six Day Multi Sport Adventure Camp (age 13-14) July 25th- July 31st $900

Backpacking 101 (age 13-14) August 1nd- Aug 7th $900

Canoeing/Camping 101 (age 13-14) August 8th- August 14th $900

Airport pick up & drop off? ___YES $100 ___NO

Weekend stay over?  ____YES $100 ____NO

Total $________

Deposit $_______

I have paid by (please check one):

__ Check enclosed (please make check out to Extreme Adventures of Vermont)

__ Credit Card

If paying by credit card:

Billing Address: __________________________________________________________

Type of Card (please circle one):  VISA    MasterCard

Name on Card: _________________________

Credit Card #:__________________________

Expiration Date: ________________________

Signature Code: ________________________

(Found next to signature on back of card)

If you would like your child to be picked up by our staff at Hartford International airport,

please give us appropriate flight information.

Please feel free to call or email with any questions you may have,

Toll Free 1-888-714-9584  campinfo@VermontAdventureCamps.com

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