Please check:

Session I (July 15 thru 21)
or
Session II (August 5 thru 11)

Age group 7 - 11

Age group 12 - 17

Full Name:  

Parents Names:  

Home Address:  

City: 

State: 

ZIP: 

Home Phone:  

Work Phone: 

E-mail: 

Emergency Contact, or Physician:

If your child is allergic to any foods, please list:

Other type allergies (plants, insects, etc.):

Give explicit information on what should be done
in case child is stung by venomous insect:

Students Interests and Hobbies:

Foreign Language Background:

Please send $100 deposit (by May 1st) to:

Jane Birdsong
Rt. 3, Box 114
Elkins, WV  26241

Now hit the "submit" button below and we will hold you a spot.

Thank you!