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 Cochlear Implant Family Camp June Session
Cochlear Implant Family Camp June Session
June 18 - June 21, 2020
YMCA of the Rockies
2515 Tunnel Road, Estes Park, CO 80511

Please fill out the form below to complete your registration online.

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*Parent Attendee’s First Name :
*Parent Attendee’s Last Name:
Title:
Organization:
*Address:
*City:
*State: (ignore for non-US transactions)
*Zip Code:
*Country (if not US):
*Email Address:
*Confirm Email Address:
*Phone:
 
Number of Family of 2 Registration - at $500.00:
 
Number of Family of 3 Registration - at $600.00:
 
Number of Family of 4 Registration - at $700.00:
 
Number of Family of 5 Registration - at $800.00:
 
Number of Family of 6 Registration - at $1,200.00:
 
Number of Family of 7 Registration - at $1,300.00:
 
Number of Horseback Rider Registrations - at $40.00:
 
Children 5 and under must ride with an adult. Children 6 and older must ride on their own horse. This is an optional activity provided by Jackson Stables to be scheduled upon arrival.
 
Number of Horsewagon Rides - at $14.00:
 
This is an optional activity provided by Jackson Stables for Saturday afternoon at 3:30pm
 

Would you consider making a donation to camp? Your registration fees cover less than half the cost of camp. Every dollar raised is important!"

Supporter Donation Amount:
( whole number, no period, no dollar sign, no zero padding please )
 
Your order total:
*What cochlear implants does your child wear?
Cochlear Americas
Advanced Bionics
MED-EL
*Do you use a hearing aid and if so what brand?
*How did you hear about camp?

Credit Card Billing Address
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Address:
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You will be asked to enter your family’s names, ages, and accommodations on the next page. As a reminder, camp is for CI children aged 3-18 years old, their siblings up to age 18, and parents/guardians only. Please contact Camp Director prior to registering for any exceptions.
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Name On Card:
C V V Value: What is CVV?
 
Yes, the organization sponsoring this event may contact me.


Refund Policy: REFUNDS AVAILABLE UNTIL 4/18/20 LESS A $75 ADMINISTRATIVE FEE.

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