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
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.*
My child is physically able to participate in outdoor activities such as hiking, rafting, and climbing.*

YesNo

SECTION 6 - Discount Eligibility
Are you eligible for any of the following?*

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 PayPal 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 PayPal or direct bank transfer.
*
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Reservation Deposit - Peak Pursuits Camp
¥50,000 Quantity

Total

¥0

Section 9 - Terms & Consent
Please review Peak Pursuits' Terms and Policies prior to filling out this form.
Agreement to abide by camp rules and regulations.*

AgreeDisagree
Consent for participation in camp activities.*

AgreeDisagree
I authorize emergency medical treatment if required.*

AgreeDisagree
I have read and accept the Terms and Conditions for cancellations and refunds.*

AgreeDisagree

Section 1 - Participant Information