Name(s) of Accompanying Adult(s) Relationship to child.

_________________________________________     _________________________

_________________________________________     _________________________

Would you be willing to share cabin accommodations with another family? ________________

Preferred family for sharing: ________________________________________________

Names of Children/ Birthday / Age / Sex

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

Do any of your registered children require special consideration or attention due to a condition presently managed by a doctor? Please specify.

____________________________________________________________________

____________________________________________________________________

Family Address:

____________________________________________________________________

__________________________________Telephone:__________________________

Please check preferred week(s):

July 2-July 8: ____________

July 9- July 15: ___________

A deposit of $100 should accompany this registration form. Balance of payment is due on June 15 or on arrival at camp. Please make checks payable to Noyes Family Weeks, c/o Patricia Guliani, 10 Farm Lane, Portland. CT, 06480

Guests will be asked to sign waivers releasing Noyes Family Camp from all liabilities. Guests must take full responsibility for their own safety within buildings on camp property and at the waterfront. Noyes Children’s Weeks are an activity of the Noyes School of Rhythm Foundation, Inc. held at 207 Penfield Hill Rd, Portland, Ct 06480. We welcome people regardless of race, creed or natinal origin.