THE CHOCONUT 2004 REUNION REGISTRATION FORM

 

Name________________________________________________

Street Address ________________________________________

City, State, Zip ________________________________________

Phone Number ________________________Email Address ___________________________

 

A. REUNION REGISTRATION

 

____  As a member in good standing, I plan to attend the Choconut Foundation Reunion on September 3^rd, 4^th, 5^th, and 6^th 2004.  I will gladly pay $60.00 for this great weekend. If not a member I can pay my dues by checking the next category below.

 

_____ I forgot to pay my dues for 2004, $15.00, so I have enclosed them here.

Besides myself, I will be bringing the following number of guest(s) at the rock bottom bargain rates:

Adults and children 15 years of age and up at $60.00 each.

____ Children 10-14 years of age at $45.00 each.

____ Children 7-10 years of age at $30.00 each.

____ Children 3-6 years of age at $15.00 each.

Children 2 years and under are free!!

 

____ As an adult with attending children I would like to participate in and/or coordinate activities for children (nature hikes, games, painting, baking, etc).

 

I will be arriving in time for:   ____ Friday Dinner, ____ Saturday Breakfast,
____ Saturday Lunch, ____ Saturday Dinner, Other _____________.

 

TOTAL $_______ for member/guest reunion fees and my annual dues if I have not already paid.

 

 

B. CAMP SCHOLARSHIP FUND

 

_____ In addition to my dues, I would like to help increase the scholarship fund to send a child to Camp Susquehannock.
            

TOTAL $_______ for Camp Scholarship Fund.

 

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A. REUNION FEES TOTAL $_______

B. CAMP SCHOLARSHIP $_______

TOTAL $_______

Please fill-in and sign the General Release and Hold Harmless Agreement (below).

.

General Release and Hold Harmless Agreement I/We, the undersigned, for myself/ourselves and for my/our children under the age of 18, intending to be legally bound, and in consideration for permission to camp on private property located at and around LAKE CHOCONUT, FRIENDSVILLE, PA, over Labor Day Weekend 2004, do hereby RELEASE AND FOREVER DISCHARGE AND AGREE TO HOLD HARMLESS:  CAMP SUSQUEHANNOCK CAMPS, a non-profit corporation, its owners, its Board of Directors and members, its employees and all others in any way connected with the operation of The Susquehannock Camps, as well as The Lake Choconut Association, its members and officers, The Choconut Foundation, its members and officers, and heirs, executors, and administrators of each and every one of them, from ALL MANNER of suits, or claims for damages or liability for injuries or accidents, which I/we, my/our children or guests, executors or administrators hereafter may have, by reason of any matter which may arise out of my/our use of equipment or facilities at the private property which I/we have been granted permission to use, or which in any way occurs during my/our attendance at the Labor Day weekend activities conducted by THE CHOCONUT FOUNDATION.

 

DATED ______________________, 2004

 

 

SIGNED BY ADULT MEMBERS AND GUESTS:

___________________________________________

___________________________________________

___________________________________________

___________________________________________

 

 

PRINT NAMES & AGES OF CHILDREN UNDER 18 YRS OLD:

1.  _________________________________________

2.  _________________________________________

3.  _________________________________________

4.  _________________________________________

 

 

 

Please fill out your Choconut Reunion Registration Form and the General Release and Hold Harmless Agreement and mail with your total payment (made out to the Choconut Foundation) by August 15, 2004 to:

Steve Perrin

Treasurer-Choconut Foundation
1497 Scio Ridge Ct.
Ann Arbor, MI  48103