College

(Post High School - 29yr)

$90

January 8-10

High School

(Entering 9th - 12th grade)

$90

January 15-17

Jr. High 

(Entering 6th - 8th grade)    

$90

January 29-31

Juniors 

(Entering 4th & 5th grade)

$90

February 5-7

Initial registration amount

I qualify for the family discount (-10%)

Sibling name      

* Discount price does not apply to bus fee

 - 

I need transportation from UACC to Camp ($34 / no bus for College)

+  

I am registering early and qualify for a discount of $10

*Please note that an early application is one that is submitted online or postmarked by:

  College - December 18       

High School - December 28

Junior High - January 4

Juniors - January 8

 -    

Total Amount Due  

Camper Name

Age

Grade (entering)

  Male   

  Female

Address

Birthday

Home Church

City

State

Zip Code

E-mail

Home Phone

First time to Camp AREV?

Yes! Any additional information would help!

Return Camper

Been before, but entering a new age group

Primary Language:

English      Armenian      Other      

Comfortable with both     Little to no English    

Little to no Armenian

*Cabin mate requests (limit two)

1.              2.

*We will do our best to honor cabin mate requests with at least one of the two selected.  Priority is given to early applicants.

Name of Parent or Guardian #1

Home Phone

Cell Phone

Name of Parent or Guardian #2

Home Phone

Cell Phone

Alternate Contact

Home Phone

Cell Phone

Please provide address/ phone where you’ll be while your child is at camp if different than above

Primary Care Physician

Office Phone

Insurance Carrier

Policy Number

Please Note:  Camp AREV carries accident insurance, however, this will not take the place of personal health insurance.  All expenses incurred in the treatment of injuries or accidents at camp will be the responsibility of the parent, guardian, or their assigned insurance carrier.

IMMUNIZATIONS (this is a new section required by the state of CA)

Please provide date of last: 

DPT/TD/Tetanus

Polio

Measles/Mumps/Rubella (MMR)

Tuberculin Test

Flu

Other immunization with dates

ALLERGIES

Bees or Insect Bites/Stings

Penicillin

Other Drugs

Foods

Type of Allergic reaction (i.e. Swelling, Vomiting)

MEDICATION

Current Medication & Dosage

(MUST BE BROUGHT IN ORIGINAL CONTAINER WITH INSTRUCTIONS)

Reason for Medication

RESTRICTIONS

Activity Restrictions

Dietary Restrictions (i.e. Vegetarian)

Any other issue we may need to know about

(bedwetting, sleepwalking, major illnesses)