All fields marked with red “*” are required. In case you will miss any required field the form will not get submitted and will show error(s) on those missed fields. Make sure you have filled the form correctly before submitting.

Camper Information

Parent/Guardian Information 1
Parent/Guardian Information 2
Health Insurance Information
Please check any session you would like to attend.*
SessionWeeksTuitionSelectExtension **
Session 1
Jun 07 to Jun 21
Session 2
Jun 21 to Jul 05
Session 3
Jul 05 to Jul 19
Extension Costs (** Subject to availability)
Two combined sessions     $4,975.00
Three combined sessions     $7,000.00
Medical Deposit * Medical deposit is fully refundable, less any portion used. Refund checks are issued by the end of October, after camp.
Cognitive Behavioral Techniques program CBT. Optional small group sessions find out when and what is causing them to overeat. Campers learn new strategies that are very effective. The price is modest.
Transportation Selection

Dear Parents,

Due to the Covid – 19 situation, all campers need to be transported to camp with an adult. When you enroll, we will send you specific information on measures we're taking to keep our campers safe. It may be possible to go home by other means at the end of camp.

Grand Total
Medical Deposit$0.00
Cognitive Behavior Therapy$0.00
Grand Total Amount$0.00
Payment Information

Our published tuition fees reflect a 3% discount for direct payment. If you would like to charge the remaining tuition balance to your credit card, amounts charged will be 3% higher. We absorb this for the initial deposit of $1000.00

Your best option is to use an e-check. There’s no fee. All you need is a checking account with your routing and account number.


(only for credit card)
Checking Account Information
e-Check logo
Credit Card Information
Credit Card logo
Card holder's Billing Information
Terms and Conditions Click to Print

By typing my name above (Digital Signature) I authorize Camp Shane, to withdraw funds from my bank account or charge my Credit Card and I agree to the terms and conditions on the Reservation Agreement, including authority to charge the balance due if the total amount owed are not timely paid as per the Agreement.