To reserve a space, please PRINT THIS PAGE and fill out the registration form and send it along with a non-refundable deposit of $100.00 per child per session made out to Mr. and Mrs. Fish, Inc. to:

Shortly after we receive your registration and deposit, we'll send you either a postcard or an e-mail confirming your space in the program. In late May/early June, you will receive a full camp information packet complete with health form, etc. which should answer any and all questions you might have.

FISH CAMP REGISTRATION FORM 2012

Name _______________________________________________________________

Age ____ | Date of Birth ____-____-________ | M ____ F ____

Address _____________________________________________________________

City _____________________________State ____________ Zip _______________

Mother's Name ________________________________________________________

Home Phone _____________ Cell Phone _____________ Work Phone ____________

Father's Name _________________________________________________________

Home Phone _____________ Cell Phone _____________ Work Phone ____________

Family E-mail __________________________________________________________

Please send confirmation via e-mail ____ or via postcard ____ _____ Session 1: Monday, June 25 to Friday, July 6 (no camp July 4) _____ Session 2: Tuesday, July 10 to Friday, July 20 _____ Session 3: Tuesday, July 24 to Friday, August 3 _____ Session 4: (one-week special edition) Monday, August 6 to Friday August 10

If you have questions, please feel free to call Jan Geyer, Fish Camp Registrar, at 767-5517.