2004 KIDS CAMP REGISTRATION FORM
Make checks payable to Jim Burns.
Complete and mail with your payment to:
Burns Hermitage Kids Camp
7240 Elkhorn Rd.
Las Vegas, Nevada 89131
(702) 256-1215
CAMPERS NAME ______________________________________
PARENT'S NAME_______________________________________
ADDRESS____________________________________
CITY___________________________ STATE_______ ZIP CODE______________
TELEPHONE NUMBER____________________ EMAIL___________________
BIRTH DATE_____/_____/_____ AGE_____
HEIGHT_____ WEIGHT_____ HAIR COLOR______ EYE COLOR______
ENROLL MY CHILD IN HUNTER EDUCATION (CIRCLE ONE) YES / NO
DOES YOUR CHILD HAVE A FRIEND ENROLLED IN THIS CAMP? YES / NO
IF YES, NAME OF FRIEND_____________________________________
PAYMENT AMOUNT ENCLOSED $__________________
PAYMENT AMOUNT DUE$_____________________
CHILD'S SIGNATURE_________________________________________
PARENT'S SIGNATURE________________________________________