There are Three Ways to Register:
1. Register here online.
2. Call us at 607-243-8126 ext. 222
3. Print out this form and mail or fax it to our office. Fax 607-243-5503

NOTE: There is a non refundable $150.00 deposit required upon registration. Registration is not complete and forms will not be mailed until the registration deposit is received. Remaining balance of $200.00 is due upon arrival.

Full Name

Email Address

Mailing Address

Home Phone:

Date of Birth:

Name of Parent / Guardian

Work Phone:

Attended Camp Before at Freedom Adventures:
Yes   No   

Church the Camper Attends:

How Many of Your Children are Attending Camp this Summer?
1   2   3   4   5   More than 5   

Payment Options:
Please Select...Pay OnlineSend a CheckPay Over Phone

Camp Week Requested:
Please Select...Week 1 Week 2 Week 3 Week 4 Week 5 Week 6

Credit Card Type:
VISA   MASTER CARD   DISCOVER   AMERICAN EXPRESS   

Name of Card Holder:

Card Number:

Expiration Date:

Security Code (three digit code on back of card)

Amount to be Charged:
Please Select...$150.00 (deposit)$350.00 (full amount)$700.00 (for two campers)$1,050.00 (for three campers)1,400.00 (for four campers)