Owl Creek Programs,
Kevin Glenn, Director
P.O. Box 7351
Bloomington, IN 47407
(812) 361-3471
kevin@owlcreekprograms.com
www.owlcreekprograms.com
Application for Youth and Teen Programs Enrollment
Participant's Name:________________________________ Age:____ Birth Date:__________
Dates Applying For: ___________________________________________________
Total Cost of Program:__________________ Deposit Amount Included:___________
Parent's Email Address: ______________________________________________________
Participant's Address: __________________________________ Home Phone: ____________
City: _________________________________________ State: _________ Zip: ____________
School Attending: ___________________________________________________ Grade: ____
Parent or Guardian 1: _______________________________ Main Number:_____________
Email Address:_____________________________________ Work Number:______________
Occupation: ________________________________ Relationship to Camper: _____________
Parent or Guardian 2: _______________________________ Main Number:_____________
Occupation: ________________________________ Relationship to Camper: ____________
How did you find out about this program?
__________________________________________________________________________
Thank you for applying to our programs! Please enclose a deposit check for $40. The remaining balance is
due on the starting day of the session. Checks must be made payable to Owl Creek Programs! At least 2
week prior to the beginning of the program we will send out a gear list, waiver forms, medical form,
questionaire, and directions.
~Thank you and we look forward to seeing you!