Name: Refreshing Mountain Retreat and Adventure Center
Address: 455 Camp Road, Stevens, PA, 17578, US
Price range: $$

Day Camp Scheduling Weeks #1-3
Please complete this form for the Day Camp attendance you expect for Weeks #1-3. As the weeks progress, we will schedule future weeks accordingly.

Child Name(s) for this schedule*

If all children will have the same schedule, you can include them all here. (NOTE: Use the “+” to add additional children). If you have children that have a varied schedule (i.e. different days of the week, or different pickup/dropoff times), please complete a separate form for each child.

Child First Name	Child Last Name	Grade Entering	Registration Form on file already (yes/no)

Person completing this form:*
First Name Last Name Best Phone#
Email of Person completing this form

Sample Schedule

After program options may vary.

RefreshingCare Day Camp Schedule

Step 1 of 4

Day Camp Scheduling Weeks #1-3