Please leave this field empty.

2017 Dates

Select a Session

Session 1 6/24–8/12 $8990
Session 2 6/24–7/16 $4050
Session 3 7/16–8/12 $4950. Year End Special: $4400
Session 4 7/23–8/12 $3690. Year End Special: $3300
Session 5 7/29–8/12 $2590. Year End Special: $2200
Parent Program Call
(weekly holdover rate of $1350)

(please call if you have a conflict with above dates. We will try to accommodate you)

Camper Information

Camper's First Name
Camper's Last Name
Date of Birth
Grade (Next Sept.)
Name of School
Home Address
State and/or Country
Zip or Postal Code
Home Phone
Business Phone (father)
Business Phone (mother)
Cell Phone (father)
Cell Phone (mother)
Email Address

Father's Work Info

Father's Firm Name
State and/or Country
Zip or Postal Code

Other Parent/Guardian Work Info

Parent/Guardian Firm Name
State and/or Country
Zip or Postal Code
How did you hear about us? (name of friend, newspaper, magazine, or referral agency) If you found us through a magazine or newspaper please specify which one.
If you used a referral agency, please select which one you used
If you were referred by a friend or relative, please include their name in the field below.

Deposit of $500 is payable upon submission of this agreement. Payable in US funds. Balance is payable on or before May 15th. Deposits refunded in full up to May 15th upon receipt of written notification. Please make check payable to Camp Pennbrook.

The camping period set forth above includes room and board, general camping program, medical and nutritional staff. Parents, relatives, and campers agree to abide by the rules and regulations promulgated by the camp directors and staff for safety, health and well being of the camp. There will be no allowance or refunds made in the event of a late arrival or early departure. Conduct inimical to the best interest of the camp will result in discharge without benefit of refund. The camp retains the right to use for publicity purposes any photographs, likenesses, statements or letters of any enrolled camper for use in any media. The camp is not responsible for loss of any personal property, i.e. clothing, radios, cameras, walkman, etc. Parent or guardian are responsible for any incidental charges incurred by campers, i.e. special prescriptions, medical or dental charges, special off campus trips, or personal shopping needs.

The above agreement constitutes the entire understanding between the parties.

Medical Information

Major Medical Carrier
Policy Number

If you wish any portion of the tuition charged, please complete the following.

Credit Card Info

Card #
Card PIN
Method of Payment
Expiration Date
Amount to be charged
Name as it appears on card
State and/or Country
Zip or Postal Code
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