Brooktondale Nazarene

Camp & Retreat Center

Family Camp
REGISTRATION FORM

PERSONAL INFORMATION
Name_____________________________________________Phone_________________

Cell Phone (s) ________________________

Street______________________________City____________________State_____Zip________

Church _______________________________ E-mail __________________________

HOUSING INFORMATION- [Check one]

~ Check in @ 3pm ~ Check out @ 11am

 Campsites: Price/
day
+AC + Septic Date In Date Out Total
Rustic (no electric/water) $10
Tent (electric & water) $15
Camper/RV (electric/water) $20
Camper/RV (50 A electric/water) $25 +$5 +$5
(Septic Maceration - $5 per tank/time)

 Private (List #) *$175 lease price for 2015 Lease Signed [ ] Lease Paid Up to Date [ ]
Cabin #
Camp Lot #

 Cabins / Rooms: Price/

day
+W&F+AC Date In Date Out Total
Cabin or Dorm (near showers) $15 +$5 +$5
Cabin (w / Toilet) $35
Motel / Dorm (w / Toilet, Shower) $35 +$5
Cabin (w / Toilet & Shower) $40 +$5
*We have assorted cabin housing options. These options vary in price per day.
All sites and cabins have public restrooms and shower house accessibility.
If you are familiar with the campgrounds and have a first choice in cabin #, please list above.
Cabins will be assigned to the first registration form received with a deposit. If you have a
second choice please list that as well.
If you are not familiar with our campground, please contact the registrar for cabin # that would
best fit your family’s needs.
For both private and camp accommodations list the names of all occupants, relationship to owner/user, and age (if under 18 years of age).
Name Relationship Age (If under 18)
Owner/User___________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
VEHICLE REGISTRATION
Do you plan to keep a vehicle on the grounds? Yes_____ No_____
If Yes: Name on registration________________________________________________
Make________________ Year_____ Color_______ Plate #__________ State________
Need Hardship Approval _______ Parking Arrangements ___________________________

Will your family have a bicycle(s) on the grounds? Yes___ No___

*All bikes are to be registered and have issued registration tags attached before use at camp.
*Each bike owner is responsible for safe use and storage of his/her bike. Owners and
guardians will be contacted about the future use of bikes used or stored in an unsafe manner.

PET REGISTRATION
Do you plan on keeping a pet on the camp grounds? Yes_____ No_____
Help us by Cleaning up after your pet. To avoid the unexpected, pets must be leased or caged.
Pet Registration Fee is $10/week *** Proof of vaccination (to be shown to registrar)_______

STAFF ONLY
Are you working as a staff member at this camp? Yes___ No___
If Yes: Where will you be staying?__________________________
*Room and/or meals agreement form must be attached.

MEAL OPTIONS
Dining Hall will be open for breakfast, lunch, and dinner daily. Beginning with dinner on
Saturday, prior to July 4th and ending with lunch on Sunday, after July 4th.
Weekly Meal Tickets available for $110-adult, $90-senior (age60+), $60-child (age 6-12) Includes all meals served
in Dining Hall.
*Clergy Discount available. 2 for 1 ticket price on weekly meal tickets only for clergy and their spouse.
Individual meals may be purchased during the week.
 Breakfast - $5 adult, $4 senior,$3 child
 Lunch - $6 adult, $5 senior,$4 child
 Dinner -$7 adult, $6 senior, $5 child

FINANCIAL COMMITMENT

Housing Total _________

Meal Tickets _________

TOTAL Due _________ (*make checks payable to: Brooktondale Camp & Retreat Center)

10% deposit (non-refundable) due to hold all housing. Confirmation of receipt will be made by phone.

SEND TO…
Attn. Family Camp Registrar
Upstate NY District Office
P.O. Box 258
Clay, NY 13041
.

Do not send after June 14.

Call in registrations to Alice Brown @ (315)488-7202.