Family Camp Registration

Thank you for your interest in Family Camp: Return to the Village! Please complete the form below.

Today's Date
MM slash DD slash YYYY
Family Members Attending
For each family member attending, enter a full name, date of birth, and phone number (if applicable) below.
Full Name
First Last
Birth Date
MM slash DD slash YYYY
Phone
Full Name
First Last
Birth Date
MM slash DD slash YYYY
Phone
Full Name
First Last
Birth Date
MM slash DD slash YYYY
Phone
Full Name
First Last
Birth Date
MM slash DD slash YYYY
Phone
Additional Information
Home Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Adult Attendee Email
2nd Adult Attendee Email
Tuition Amount (choose one)
- FAMILY RATE: Each adult: $150 – $350 (sliding scale), each child: $100
- ADULTS REGISTERING AS INDIVIDUALS: $300 – $400 (sliding scale)
CAPTCHA

For more information contact us at earthartsithaca@gmail.com

Family Members Attending