Camp Matoaka Alumni Reunion Registration Form

Camp Matoaka Alumni Reunion Registration

Celebrating 60 Years!
June 4th - 6th, 2010

Personal Information

First Name:

Maiden Name:

Last Name:

Date Of Birth:

Mailing Address:

E-Mail Address:

Home Phone:

Cell Phone:

Occupation:

Children (List Names & Ages):

Camp History

First Year as a Camper:

Last Year as a Camper:

Queen Year:

Total Years as a Camper:

Notable Honors as a Camper:

First Year as a Counselor:

Last Year as a Counselor:

Total Years as a Counselor:

Counselor Position(s):

"Last Will's" or Favorite Camp Memories:

Bunk Requests:

List other attendees to the reunion:
Only spouses who are alumni and daughters ages 7 to 12 may attend.

Travel

I will be arriving to camp on:

Arriving By:
If you clicked on Air Travel, please complete the following flight information, if known.

Departing From:	Arriving In:	Airline:
Flight Number:	Departure Time:	Arrival Time:

I will require pick up from Portland Airport on Friday June 4th, 2010 between 12:00pm - 2:00pm.
I will require drop off to Portland Airport on Sunday June 6th, 2010 after 9:00am.

Notes
Provide any additional details we may need to know in the box below:

Payment

Adult Participants:

Child Participants:

By Check
Please send check payable to "Camp Matoaka" to this address:

Until Sept. 15th, 2009

Camp Matoaka
One Great Place, Smithfield, ME 04978

After September 15th, 2009

Camp Matoaka
15 Canavan Circle, Needham, MA 02492

By Credit Card
Please fill out the information below:

Card Type:   Name On Card:
  Card Number:   Security Code:   Expiry Date:

The participant signed below recognizes that certain dangers and hazards exist in many camp events and programs due to the nature of the camping experience and environment. The participant and all accompanying minors named above, acknowledge that Camp Matoaka has taken safety measures to minimize the risk of injury to all camp participants. The participants further understand that the camp cannot insure or guarantee that the participants, equipment, premises and/or activities will be free from hazards, accidents and/or injuries. Therefore, I agree to release and indemnify, that is, hold harmless Camp Matoaka, its agents and staff with regard to any claims for damages, accidents or injuries.

I agree according to the above terms and conditions:
(type your full name and today's date to confirm)

Full Name:   Date:

Submit Form