CAMP NAKANAWA

1 CAMP NAKANAWA . 1084 Camp NAKANAWA Road ~ Crossville, Tennessee 38571-2146. (931) 277-3711 ~ FAX (931) 277-5552. Please Attach Office e-mail: Recent Photo Web Site: (information, pictures, newsletters). Camper e-mail address: (put name, camp & cabin # in subject line). Ann & Pepe Perron: Directors Please enroll my daughter as a member of: Two Week Session: June 16- June 29, 2019 Four Week Session: July 1 July 28, 2019. $ $ __ Junior 8-11 years (Completed Grades 2-5) __Junior 8-12 years (Completed Grades 2-6). __Intermediate 11-14 years (Completed Grades 6-8)__Intermediate 13-14 years (Completed Grades 7-8). __Senior 15-17 years (Completed Grades 9-11). The Registration Fee of $400 2WK/$450 4WK accompanies this application. In making request for enrollment, my daughter promises to be a loyal camper, to uphold the ideals of NAKANAWA , and to be an integral part of NAKANAWA for the entire session.

2 Camper's Name:_____. (First) (Middle) (Last). (Please underline name camper wishes to be called) Camper's e-mail address:_____. Street Address:_____Home Telephone:_____. City:_____State:_____Zip Code:_____. FAX Number:_____ Parent's e-mail address:_____. Date of Birth:_____Height:_____Weight:_____Soc. Sec.#_____Age:_____. Please include copy of Insurance Card, front and back, & policy holder's SS# and Birthdate. School Attending:_____Grade completed as of June 2018:____. Number of Years at NAKANAWA :2wk____4wk____Team:A__V__Other Camps Attended_____. Through whom did you learn of NAKANAWA ?(name please)_____. Religious Preference:_____If Catholic, will your daughter attend Mass? Yes No Are Parents Divorced, Separated or Either Parent Deceased?_____. If so, with whom do you reside?_____Relationship:_____.

3 Brother(s) & Sister(s) Names & Ages:_____. Mother's Name:_____Occupation:_____. Home Address, if different:_____Work Telephone:_____. Cell Phone or any other Emergency Number:_____. Father's Name:_____Occupation:_____. Home Address, if different:_____Work Telephone:_____. Cell Phone or any other Emergency Number:_____. Mail Billing to:_____. Send Weekly Newsletters by e-mail to:(address)_____. Is Mother or Grandmother a Former NAKANAWA Camper or Counselor?_____Years:_____. Maiden Name(s)-First & Last:_____Team(s):_____. Is Sister a Current/Former Camper?___Name:_____Team:_____. Activities to be Encouraged:_____. Activities to be Restricted:_____. Advance notice by May 1st for acceptance of modified menu/Doctor's orders required: Please specify any special dietary needs:_____. Please specify any daily medications:_____.

4 Please specify any severe allergies:_____. T-Shirt size (circle one) YS YM YL S M L XL XXL. Please read carefully. The following must be signed to complete application. 1. In the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by the Camp Directors to hospitalize and/or treat my child and agree that I will be financially responsible for any charges for services provided by medical professional for any accident, injury, or illness incurred while enrolled at Camp NAKANAWA . 2. I give permission for photographs or video footage of my daughter to be used by the camp for promotional purposes. 3. All activities at Camp NAKANAWA , Inc. are supervised by competent personnel with every precaution exercised for the safety of the campers and staff.

5 However, Camp NAKANAWA , Inc., cannot be responsible for accidents or incidents which may occur in any activity. 4. Camp NAKANAWA , Inc., cannot be responsible for accidents or incidents which may occur in activities or field trips that take place outside of camp facilities located in Mayland, Tennessee. 5. If a camper chooses to leave the camp session early, she is allowed to return to camp as a visitor, but not as a camper, unless prior arrangements have been made with the directors. 6. This application is made with my consent and approval of the conditions listed here and in the catalog, and I hereby certify that my child is of good moral character. She has my permission to engage in all prescribed activities, except as noted by me above. Signature:_____Date:_____. Please share information concerning your daughter that you feel would be helpful in making her camping experience a success.

6 Also, please express any special desires you have for your daughter and what you expect her to gain from _____. _____. _____. Cabin Mate Request (limit 2): 1_____2_____. REFERALS-Please send information about NAKANAWA to the following prospective camper: 1. Name:_____Age:_____. Parent's Name:_____. Address:_____. 2. Name:_____Age:_____. Parent's Name:_____. Address:_____. THE CAMP FEE IS SUGGESTED TO BE PAYABLE AS FOLLOWS: TWO WEEK CAMP - TUITION: $ SUNDAY, JUNE 16TH SATURDAY, JUNE 29TH, 2019. Registration Fee $ First Payment February 1st $ Final Payment April 1st .. $ FOUR WEEK CAMP - TUITION: ..$ MONDAY, JULY 1ST SUNDAY, JULY 28TH, 2019. Registration Fee $ First Payment February 1st $ Final Payment April 1st . $ Rental Linens (International Campers Only) $ TO BE ENROLLED, COMPLETED REGISTRATION FORM (& PICTURE) MUST BE ACCOMPANIED BY THE REGISTRATION FEE.

7 PARTIAL REFUND OF REGISTRATION FEE WILL BE GRANTED IF CANCELLATION IS MADE PRIOR TO MARCH 1 ST. KEEP THIS PAGE CAMP NAKANAWA CENTENNIAL SEASON. 1084 Camp NAKANAWA Road ~ Crossville, Tennessee 38571-2146. (931)-277-3711 ~ FAX (931)-277-5552. Office e-mail address: Web Site: (information, pictures & newsletters) (user name: red ~ password: blue). Camper e-mail address: (put name, camp & cabin # in subject line). 2019 GENERAL INFORMATION. TWO WEEK CAMP - TUITION: .. $ FOUR WEEK CAMP - TUITION: $ SUNDAY, JUNE 16TH SATURDAY, JUNE 29TH, 2019 MONDAY, JULY 1ST SUNDAY, JULY 28TH, 2019. Registration Fee ..$ Registration Fee $ First Suggested Payment February 1st .$ First Suggested Payment February 1st ..$ Second Suggested Payment April 1st ..$ Second Suggested Payment April 1st . $ Rental Linens (International Campers Only).

8 $ ARRIVAL By Car with parent between 1PM and 4PM 6/16 or 7/1. Tent Row may arrive 6/29 at 2PM. By Plane:see Transportation below. TUITION The tuition fee covers all normal expenditures: board, lodging, laundry, transportation from and to the Nashville Airport, special trips, equipment in all activities, instruction and supervision by a staff of competent counselors, and also the services of the Camp Infirmary including our camp physician. In the unlikely event of an accident or illness requiring a trip to one of our local physicians or specialists, or the need for a prescription while at camp, our office will contact you for additional information to pay for health care services. We will forward the necessary paperwork so that you can submit the claim to your insurance for reimbursement.

9 ADMISSION NAKANAWA is open to girls of good character between the ages of 8 and 17. The two week session is open to girls that are 8 to 14 and have completed grades two through eight. The four week session is open to girls that are 8 to 17 and have completed grades two through eleven. Each girl is expected to conform to the rules and regulations of NAKANAWA and the guidelines set forth by each team. We expect our girls to be loyal campers and to cooperate with the Directors and camp personnel. We do not allow smoking, profanity, alcohol or drugs other than those prescribed by a doctor. The Directors reserve the right to dismiss any girl or deny admission to any applicant who, in our opinion, is deemed undesirable or whose presence would be detrimental to the best interest of NAKANAWA .

10 In the event of dismissal or withdrawal for any reason, no part of the camp fee will be refunded, except when withdrawal is advised by a physician. Girls who have completed grades 2nd-5th are eligible for admission to Junior Camp for the two week session. Girls who have completed grades 6th-8th will be eligible for Intermediate Camp for the two week session. Girls who have completed grades 2nd-6th will be eligible for Junior Camp for the four week session. Girls who have completed grades 7th-8th will be eligible for Intermediate Camp for the four week session. Girls who have completed grades 9th-11th will be eligible for Senior Camp for the four week session. Should there be any question as to which camp will be most suitable for a camper, it would be best to discuss placement with the Directors before reaching a decision.