|
Registration
Name________________________________ Home Phone_______________________________ Address___________________________________ Other Phones____________________________________ City_________________________________
_______________________________________ State__________Zip_____________
_______________________________________ Age ____ Sex ___ T-Shirt Size (Circle One) Youth: S M L Adult: S M L XL Birth Date________________________ Nickname_______________________________ Parents’ Names __________________________________________________________________ Parents' Employer(s) _________________________________________________________________________ Physical Address(es)__________________________________________________________________________ Emergency Contact #1 ____________________ Phone _______________________________ Physical Address________________________________________________________________ Emergency Contact #2 ____________________ Phone _______________________________ Physical
Address_____________________________________________________________________ Physician’s
Name _________________________ Phone
_______________________________ Person(s)
other than Parents permitted to pick up camper: _________________________________________________________________________________ School
Last Attended ______________________ Previous Programs ____________________________________________________________________________ Allergies or Medical Conditions:
Please describe your child's swimming ability:
How did you hear about Field Camp?: My
child has permission to travel in camp-approved transportation and to
participate in all activities, including swimming. I
authorize the camp to provide or consent to emergency medical care or treatment of my
child. I agree to pick up an ill child when notified. I understand
that camp involves risks, and I agree not to hold Field Camp liable for
injuries sustained during camp or charges incurred in medical
I understand that I am responsible for payment of camp fees, that these are due in full at the time of attendance, and that payment is required regardless if the child/adult attends. Deposits are non-refundable, non-transferable, and will be applied to the last week of camp attendance. I have read these policies and understand that this is a legal and binding contract. Signature
of Parent or Guardian ___________________________ Date __________________
Full! June 14-18
Full! June 21-25
Full! June 28 - July 2
Full! July 5-9
Full! July 12-16
Full! July 19-23
Full! July 26-30
____ August 2-6
____ August 9-13
Full! July 5-16 Leadership School Session I
Full! July 26 - August 6 Leadership School Session II Summer
Fees, Hours, and
Information: The Camp day runs from 9 to 4 (except on the Thursday Overnight). Aftercare is available until 5:00 at camp and until 5:30 if taking the shuttle into Charlottesville. A camp shuttle will run each day (except Thursday afternoon and Friday morning) from the Barracks Road area, leaving at 8:30 and returning at 5:15. Because we like to have the opportunity to get to know kids (and for them to get to know us), we encourage multiple-weeks enrollment. Camp fees are $350 for one week of enrollment, $275 per week for two weeks of enrollment, or $225 per week for 3 or more weeks of enrollment. Enrollment is limited. You can reserve space with a not transferable, not refundable deposit equal to the last week of your child's enrollment. The fee for Leadership School is $700. The not transferable not refundable deposit for the School is one-half the fee for the program. Additional Questions for Leadership School students only: The following questions are for applicants to leadership school to answer so that we may have a better sense of his/her interests and experiences. There is no wrong answer! Height: Weight: Please describe any significant medical conditions and medications: (e.g. Asthma, migraines, hyperactivity, etc…)
What kind of outdoor or physical activities have you participated in previously? (Camps, sports, etc…)
What has been your greatest achievement of the past year?
Why are you interested in being a part of this program?
What do you anticipate will be your greatest challenge in this program?
|
|
|