2017 Camp Kiya Registration Form

Please fill out and submit this registration form.
Then, fill out and submit a Musical Interests Form for each camper included in your registration payment.
Thank you!

You may request a copy of your submitted form at the bottom of this screen.

Payment by check:

Request a copy of this form be sent to you, by checking the box at the bottom of this page.
Print the form from your email, then send with your check.
Or if you prefer, you may download and print the Registration Form PDF.
Checks payable to: Camp Kiya, 206 East F Street #5, Tehachapi, CA 93561
Check the Fee Schedule for prices and discounts and calculate the fees here.

Payment by credit card: 

Sorry, we no longer use PayPal. If you would like to pay with a credit or debit card, you may do so by calling 661-823-9994. Simply leave your name and telephone number and we will get back to you within a few days to take your payment over the phone.

Main Registrant Name:*
Contact E-mail:*
Camper #1 Name:
Age #1, if under 22 - Gender M/F:
Camper #2 Name:
Age #2, if under 22 - Gender M/F:
Camper #3 Name:
Age #3, if under 22 - Gender M/F:
Camper #4 Name:
Age #4, if under 22 - Gender M/F:
If you have more than 4 campers, list additional campers here; Name - Age if under 22 - M/F:
Please check one: I/we will be sleeping in a..
Cabins sleep 10. Please name others who would like to share your cabin:

We have hotels in town, 15 minutes away, ranging from $69/night to $100 or more.
If you prefer this option a list of hotels and prices will be emailed to you.
Most serve breakfast, so you can save $25 off the meal service price by using this option.

No. of Adults:
No. of Students:
Total payment due (see fee schedule):
Amount paid online using PayPal:
Amount paid by phone or check:
Balance Due:
Security Code: