rEGISTRATION FORMs

In order to secure a spot at Camp Rockledge, please fill out and submit the registration form below and make a full or 50% payment of the total price. We accept payment via Zelle, PayPal, Check or Money Orders.

Please make your check or money order payable to: Elena Routchka and mail it to:

513 Snow Hill Rd. Canadensis, PA 18325

Please check for availability before you register!

Summer Registration Form

Camper's Name:

First Name

Last Name

Camper's Age:

Date of Birth:

Parent's Name:

First Name

Last Name

Home Phone Number:

(###)

###

####

Home Address:

Parent's Work Phone:

(###)

###

####

Parent's Cell Phone:

(###)

###

####

Email Address:

Please indicate how many weeks you wish to register for. Please see our session dates on "Information & rates" page. A $25 registration fee is applied.

Please indicate the dates you wish to attend:

Please indicate if your child has any allergies:

Please indicate if purchasing ATV package:

Please indicate if purchasing Kayak package:

Do you give permission for staff to share photos of your child on the camp website and/or social media?

Yes

e-Signature

By typing your name, you agree your electronic signature is the legal equivalent of your manual signature on this Agreement.

First Name

Last Name

Winter Camp Registration Form

Camper's Name:

First Name

Last Name

Camper's Age:

Date of Birth:

Parent's Name:

First Name

Last Name

Home Phone Number:

(###)

###

####

Home Address:

Email Address:

Please indicate how many weeks you wish to register for:

Please indicate the dates you wish to attend:

Please indicate if your child has any allergies:

Do you give permission for staff to share photos of your child on the camp website and/or social media?

Option 1

Option 2

e-Signature

By typing your name, you agree your electronic signature is the legal equivalent of your manual signature on this Agreement.

First Name

Last Name

additional documents

Please fill out the forms below, sign and send to:
513 Snow Hill Road
Canadensis, PA 18325

rEGISTRATION FORMs

513 Snow Hill Rd. Canadensis, PA 18325Please check for availability before you register!

additional documents

513 Snow Hill Rd. Canadensis, PA 18325

Please check for availability before you register!