Print and Mail

Download our application here: 2017 Application
If you have difficulty downloading our application, please don’t hesitate to call or email us for assistance or to have a copy sent to you directly. Thanks!

Phone: (866) 213-4717
Email: [email protected]

Apply Online

Fill out and submit the form below, and we will get in touch with you shortly to finalize the application and proceed with payment. Thanks!

Camper Information
First Name*
Last Name*
Nickname
Age*
As of June 2017
School Grade finished in June 2017*
Date of Birth*
Sessions
Please check all sessions desired:
All sessions begin on Sundays and end on Saturdays

Two weeks $2562, Three weeks $3843
Five weeks $6405, Eight weeks = $8800
Session Choices*
- Session 1 - Three weeks, June 25-July 15
- Session 2 - Two weeks, July 16-July 29
- Session 3 - Three weeks, July 29-August 19
Parent Information
Name*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone*
Cell Phone*
Work Phone*
Email*
Would you like to add information for a second parent?
- Yes
Second Parent Information
Name*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone*
Cell Phone*
Work Phone*
Email*
Additional Parent Info
Child resides with*
Photo Release*
- Permission is hereby given to use photographs and video media in which the applicant appears for publication and similar use.
Date*
Supplemental Information
We appreciate your providing the following information:
Special Needs or Other Information
Please indicate here any special needs or other information with which we should be familiar. A difficult year in school, recent changes in family structure or complicated health-care requirements can be very useful background knowledge, and will be shared with staff "as needed" by the directors. Please note any special needs which will affect her time at camp.
Swimming Preference*
Betsey Cox believes that learning to swim is a life skill that all children should have access to. Camp follows the Red Cross Swim program for lessons and asks that campers participate in swimming instruction three times per week. It is important for us to know your family’s expectations for your daughter and her involvement in camp swimming lessons. Please indicate your wishes here by checking a box and add a comment if you wish!
- We would like our daughter to participate in swimming lessons three times per week.
- Our daughter may choose how often she participates in swimming lessons.
Current Red Cross swim level (if known)
Comment
Cabin Group Requests
We generally house girls by grade level and/or age. We will attempt to place friends together; please list no more than TWO (2) persons in your own age/grade. We won’t put girls from the same town or school together in groups larger than four. If you are part of a group larger than four, we encourage suggestions on how the group might be split.
Hobbies and Interests
Camp activities that interested you
How did you hear of Camp Betsey Cox?
Previous years at Betsey Cox
Sibling(s) at Sangamon

Application

Print and Mail

Apply Online

Camper Information

Sessions

Parent Information

Second Parent Information

Additional Parent Info

Supplemental Information