John Muir Mountain Day Camp
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Sign me Up for the John Muir Mountain Day Camp!

Registration Form

(Please Print this page out, and fill it out clearly)

Choose which session you would like to attend:

___ Session One: July 28 -Aug 1, 2008

___ Sesson Two: August 4-8, 2008

Student Name: ______________________________________________________

Student Age: _______________________________________________________

Parent/Guardian: _____________________________________________________

Home phone: ________________

Work Phone:_________________

E-mail Address: ___________________________________________

Address: ________________________________________________

City ________________________________________State _______

Method of payment (circle):    Cash    Check    AmEX    Visa    MC

Card Number: ________________________________________________________

Expiration Date: __________________

Amount: $235.00
(contact us for multiple child discounts)

Signature: ________________________________________________________

Mail form and Fees to:

Make checks payable to: Willows Theatre Box Office
Attn: John Muir Mountain Day Camp
636 Ward Street
Martinez, CA 94553

Telephone: (925) 798-1300
E-Mail: info@muircamp.org
Web: www.muircamp.org