Sign Up Form

Homesteader Name:
Parent Name:
Address:
Town:State:Zip:
Phone Number:Cell:
Email Address:
Birthdate:
School and Grade as of Sept. :
	I enclose a non refundable deposit of $50
	I enclose the full enrollment fee of $500
	I'm interested in a campership for my child and want to enroll my child now. Please call me.
	We consent to let Village use photographs of my/our child on marketing material.
How did you hear about Village?

Please mail your completed form to :

The Game of Village
PO Box 323
Keene, NH 03431

The Game of Village Inc. is a non-profit 501(c)3 organization founded in 1983.