If you prefer to speak to someone about the Great Gluten Escape
Camp,
use the Contact page.
Effective May 2,
2008, the Great Gluten
Escape Camp electronic registration has been closed. We have
limited space available based on age and/or gender limitations.
We will place campers on a waiting list with a fully paid camp
deposit of $100. This deposit is non-refundable if the camper
is placed. For campers not placed the deposit will be refunded.
We expect to complete all waiting list selections by May 20th,
2008, however we will continue to offer placement to campers
on the waiting list in the event we have cancellations after
May 20th, 2008.
It is our policy to return all registrations that are not complete,
that do not have the complete deposit, or that have contingencies.
For more information please contact the camp registrar via email
or 972-727-4654.
Late Registration/Partial Payments:
Effective May 2, 2008 the camp fee will increase to $425
and full payment will be required at the time of placement from
the waiting list. Any paid camp deposit will be applied to the
late registration fee. If written cancellation notice
is received by May 15, 2008, any camp fees paid will be refunded
(not including the non-refundable deposit of $100).
Additionally, any remaining balances not paid
in full by May 1, 2008 will be subject to a late fee of $30.
To make a partial payment click
here
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Registration
Date:
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(Ex.MM/DD/YYYY) |
Camper
Information |
Last
Name:
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First
Name:
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Middle
Name:
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Preferred
Name:
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Address:
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City:
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State:
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(Please choose
state) |
Zip
Code:
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Phone:
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(Ex. 999-999-9999) |
| Age: |
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| Gender: |
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Date
of Birth:
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(Ex.MM/DD/YYYY) |
School
Grade (use current year):
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Payment
Method:
Payment may be sent
to:
Great Gluten Escape Camp
1019 Rockefeller Lane
Allen TX 75002 |
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Dietary
Restrictions:
DF Note: The camp will serve gluten-free
food and accommodate dairy free diets as needed. All dairy
free campers will be required to stay dairy free during camp.
For other food restrictions, contact the Camp Nurse BEFORE
you register.
Camp Nurse: Cheryl Gainer, RN
ggenurse@dallasrock.org or
(214) 274-6094. |
*
*
- see note about DF
*Leave this box un-checked if the camper is not
diagnosed (by a licensed physician) with celiac disease/gluten
intolerance. This information is collected specifically for grant
writing purposes. The camper does not have to be a diagnosed celiac
to attend camp. |
| T-shirt
Size: |
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| Ethnicity
(optional) |
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| Camper
is under the custodial care of: |
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Mother
or Guardian Information |
| Name: |
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| Address: |
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| City: |
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| State
& ZIP: |
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| Home
Phone: |
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| Work
Phone: |
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| Cell
Phone: |
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| Email
Address: |
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Father
or Other Guardian Information |
| Name: |
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| Address: |
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| City: |
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| State
& ZIP: |
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| Home
Phone: |
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| Work
Phone: |
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| Cell
Phone: |
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| Email
Address: |
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Camp
Referral |
| How
did you hear about our camp? |
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Camper
Health History |
| Check all that apply: |
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Is an EpiPen required?
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Chronic/Recurring
Conditions |
Check
all that apply:
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| Other
Conditions? |
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Allowable
Medicines |
| Check
all that apply: |
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| Other
Information |
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| Check
all that apply: |
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| Other
Special Devices? |
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Comments,
questions or observations?
You may also use this area for accommodation or other special
requirements, including other food intolerance.
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