Peak Pursuits - 2026 Summer Camp Registration Form

Peak Pursuits - 2026 Summer Camp Registration Form

July 27–31 | 5 Days / 4 Nights | All-inclusive residential adventure camp
*Please complete one registration form per child. If registering multiple children, submit the form again after completing payment.
Section 1 - Participant Information
Email Address*
example@example.com
Child's Full Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Age*
Residential Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Gender
Any previous camping or outdoor experience?
Any specific activities the child is particularly interested in or hesitant about?

SECTION 4 - Medical & Safety Information
Are there any medical, behavioral, or emotional concerns that staff should be aware of? If yes, please explain in detail.*
Any dietary restrictions or allergies?*
Any medications your child is taking? If yes, please list here.*
YesNo

SECTION 6 - Discount Eligibility
Early Bird registration (before June 31)Sibling discount (registering more than one child)BothNo

SECTION 7 - Payment Options & Completion
To confirm your child’s place in the program, a reservation deposit of ¥50,000 is required at the time of registration.

The deposit is paid securely via Stripe when this form is submitted.

Once your registration is reviewed and any applicable discounts are confirmed, we will send an invoice for the remaining balance. The balance may be paid by Stripe, PayPal or direct bank transfer.

Reservation Deposit - Peak Pursuits Camp*

Summer Camp Reservation Deposit

To confirm your child's place in the program, a reservation deposit of ¥50,000 is requires at the time of registration.

¥50,000

Total

¥0

Section 9 - Terms & Consent
Please review Peak Pursuits' Terms and Policies prior to filling out this form.
AgreeDisagree
AgreeDisagree
AgreeDisagree
AgreeDisagree

*Please complete one registration form per child. If registering multiple children, submit the form again after completing payment.