Dyken Pond Environmental Education Center

On the Rensselaer Plateau

Please complete all information below. A separate page and PayPal, or credit card, payment must be completed for each additional child:

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Child's First Name: Child's Last Name:

T-Shirt Size: T-Shirt Body Style:

Gender (choose one): Child's Age in August:

1st Camp Dates, age based (Choose one):

Camp Fees (Choose one): Note Refund Information to the right

Parent's First Name: Parent's Last Name:

Additional Parent's First Name (optional):

Additional Parent's Last Name (optional):

Address:

City: State: Zip:

Telephone: Email:

An additional $5 to process the OAC registration using PayPal
will be charged during checkout and appear as "Shipping and Handling".