Camp Kupugani

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Camper Information

I am over 18 Years Old *

Attending Session: *
Sunday June 24 - Saturday July 21 (4 weeks)
Sunday June 24 - Saturday July 7 (2 weeks)
Sunday July 8 - Saturday July 21 (2 weeks)

Camper's Name: *
Grade (Fall of 2012) : *
Age: *
Adult T-shirt size:
Birthdate: *
Address: *
City: *
State and/or Country: *
Zip or Postal Code: *
Home Phone & Area Code: *
Home Fax:
Home Email: *
Present School Name & Community: *
Camper Email:
From whom did you hear about camp?: *
Is the camper living with both parents?: *
If no, send invoice to:
If not with both parents, parents are:

Please describe your camper's race(s)/ethnicity(-ies)*: *Providing the information above is optional, yet it would be tremendously helpful if you did. Because we are addressing issues of difference, it is essential that we have a diverse group of campers. We not only strive for racial/ethnic diversity, but also for diversity of socio-economic class, religion, culture, personality, etc. This information will be used only to determine this balance.

Please describe any other ways by which she identifies herself (such as socio-economic class, religion, culture, background, etc.) that you would like to share with us:

Parent Information

Parent's Name: *
Address (if different than above):
Occupation: *
Business Phone: *
Business Fax:

Other Parent's Name: *
Address (if different than above):
Occupation: *
Business Phone: *
Business Fax:

Camp Referral

Fill in the name of an interested family & we'll send them our video/brochure! If they enroll in camp, you'll receive a 5% credit!

Parents Referral:
Children's Names:
Ages:
Address:
City:
State:
Zip Code:
Home Phone:
Email Address:

Camp Kupugani Policy

Account balance due April 1, 2012.
An invoice is sent upon enrollment and updated with a monthly statement. The orginal invoice will include tuition, the camper’s store account deposit, and deposit credit. If you wish to make periodic payments, send payments whenever you wish. MasterCard, Visa, and Discover are accepted for payments in full or on an installment basis. Priority registration discounts require automatic monthly Credit Card payments.
No reduction in fees for late arrival or early departure.
Cancellations received before February 1, 2012 will receive a full refund. If an application is cancelled after Februrary 1st, 25% of tuition will be retained. Cancellations after April 1st, but before 30 days prior to your selected session will have 50% of tuition retained. Cancellations within 30 days of the start of the selected session will forfeit full tuition. No reduction of fee is made for late arrival, early departure or dismissal, unless special arrangements have been approved (in writing) prior to camp.
Sister Discount - 10% tuition reduction for each additional child in the family after the first child is enrolled at full tuition.
Referral Credit - 5% tuition credit for each enrolled camper who tells us you referred her to Camp Kupugani; although you can receive multiple referral credits, each incoming camper can list only one person as the referral.
A resident medical staff is available for routine medical services, but the cost of special medications, illness expenses, hospital costs, or consulting doctors are not included in the camp fee. Camp Kupugani does not carry camper medical or accident insurance. Bills for such claims will be sent directly to the parents’ insurance company or to the parents by physicians, clinics, and hospitals involved.
Campers do not need cash at camp. We cannot be responsible for clothing, watches, jewelry or other personal property brought to camp. We highly recommend the use of nametapes for marking clothing and gear. Cell phones and personal music players using headphones (such as ipods) are not permitted at camp.

We are so confident that your daughter will have fun changing her world that we offer a money back guarantee. However, the use, possession, or involvement in smoking, drinking, or unauthorized drugs, or any conduct that is not in the best interest of the camp, including physical or verbal abuse is cause for immediate dismissal from camp without tuition refund.

2012 Camp Fees:

		Pay by:	Oct. 1st	Dec. 1st	Mar. 1st
4-Week Tuition:	$3350		$2825	$3000	$3200
4-Week Camper's Store Account (Deposit for personal use in Camp Store):	$200		$200	$200	$200
2-Week Tuition:	$1795		$1545	$1620	$1720
2-Week Camper's Store Account (Deposit for personal use in Camp Store):	$100		$100	$100	$100
Personal expenses vary from camper to camper. A refund of unused funds is rendered at the end of each session. A confirmation will follow each application. Detailed camp information and forms will be sent in the spring.

Parents and campers understand that any video, portraits or pictures of the camper taken at camp, and quotes or other written materials may be used by Camp Kupugani or assigned agents for art, advertising and promotional literature. Parents and campers waive the right to inspect and/or approve the finished product or copy.
We practice safety at all times; however, participation in camp life and activities has inherent risks and injuries sometimes do occur. With enrollment, parents acknowledge and accept this fact and agree to hold harmless the camp, its employees, and agents against any and all claims, damages and injuries.
The application and deposit constitute an enrollment agreement only when accepted in writing by a Camp Kupugani Director and shall be construed in and under the laws of the State of Illinois. Any controversy or claim arising out of or relating to this enrollment agreement or a breach thereof shall be filed with and settled by the American Arbitration Association's Illinois regional office in accordance with the then existing Rules of the American Arbitration Association, and any award rendered by an arbitrator may be entered in either the Second Judicial District Court of Illinois, or the United States Court, Northern District of Illinois. This agreement shall be construed and enforced in accordance with the laws of the State of Illinois. We consider your enrollment and/or payment as acknowledgement and acceptance of all the terms of this agreement

* I Agree To The Terms Above:

I would like to contribute $ to the Kupugani Scholarship Fund, so a deserving girl can attend camp.

Have Fun Changing Your World

Express Yourself, Build Self-Esteem, Be Nurtured, Be Safe

Camp Kupugani Policy

2012 Camp Fees:

Camp White Eagle