NAME OF GROUP OR ORGANIZATION:
______________________________________________________
ADDRESS: _____________________________________________
CITY/STATE/ZIP ______________________________________
DAYTIME PHONE______________EVENING PHONE___________
WORK CAMP TYPE REQUESTED:
DATES REQUESTED: (Please list your first, second, and third choices) I/We have read the Guidelines and Policies for Work Camps at Refugio del Rio Grande and understand and accept the terms as set forth in those documents. Our group will abide by the policies and rules of Refugio del Rio Grand while we are at Refugio and will respect permanent residents and refugees who are in residence during our stay. We understand that Refugio del Rio Grande has the right to enforce its policies and rules during our stay. *For student groups, this signature should be that of the principal or another faculty member with responsibility for the group.
_____Dedicated Work Camp
_____Weekend Dedicated Work Camp
_____Educational Work Camp
_____Weekend Educational Work Camp
_____Combination Work Camp
_____One day experience (Circle one - Work or Educational)
First Choice: ____________________________________________
Second Choice: _________________________________________
Third Choice: ___________________________________________
___________________________
Signature, Contact Person
_______________________
Signature, Director of Organization*
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