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Enrollee's name*
Gender*
What is your preferred trip?*
Alaska
Hawaii
What is your alternate choice if your preferred choice is full?
Alaska
Hawaii
Date of birth*
Age as of June 30, 2010*
Grade in 2009-10 school year*
School (name and address)
Applicant lives with:*
both parents
mother
father
stepparent
Other:
Father's (or Guardian's) Information
Name
Home address
Home phone
Cell phone
E-mail
Business name
Title
Business address
Business phone
Business fax
Summer address / dates
Summer phone
Mother's (or Guardian's) Information
Name
Home address
Home phone
Cell phone
E-mail
Business name
Title
Business address
Business phone
Business fax
Summer address / dates
Summer phone
Names and ages of siblings
If parents are divorced or separated:
Who has legal custody of the child?
To whom should mailings be sent?
To whom should billings be sent?
Signature of parent or guardian*
Date of application*
Please send $1000 deposit to: Treetops Expeditions 4382 Cascade Rd. Lake Placid, NY 12946 Or submit credit card information below (Visa, Mastercard, American Express)
Cardholder’s Name:
Credit Card Type:
Card Number:
Expiration Date:
CV code (3 digit number on back of credit card)?
INFORMATION ABOUT APPLICANT
Did a family member attend Camp Treetops, North Country School, or a Treetops Expedition?
Who? When?
How did you learn about Treetops Expeditions?
Has your child ever participated in a wilderness experience?
If so, when?
Type of experience and location?
Are there any special skills you would like emphasized with your child?
Are there any concerns about your child of which we should be aware?
Is your child a vegetarian?
Are there any food allergies, restrictions, needs, or practices?
Does your child have: (check any that apply)
a sight impairment
a hearing impairment
a learning disability
an emotional concern
a physical disability
any medication
a special need
Please explain in detail if any of the above were checked.
Has your child a talent you wish to tell us about?
Has your child a particular interest you wish to share with us?
Please take a moment to share Treetops Expeditions with a friend. If you or your child know people who should know about TTX, please write their name and address here. We will promptly send them information. Thank you.

Please Note: Questions marked with an asterisk (*) are required.
   4382 Cascade Rd   |   Lake Placid, NY 12946   |   Ph 518 523 9329   |   F 518 523 4858
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