Parent/Guardian Information

Guardianship Information
Child Resides With:	Both Parents Father Mother Guardian	Legal Custody (if separated):	Father Mother Guardian
Who is Filling Out Form?:	Father Mother Guardian

Father’s Information
Father’s Name:		Father’s Occupation:
Father’s Work Phone:		Father’s Home Phone:
Father’s Cell Phone:		Father’s Email:
Father’s Home Address (if different from child’s):

Mother’s Information
Mother’s Name:		Mother’s Occupation:
Mother’s Work Phone:		Mother’s Home Phone:
Mother’s Cell Phone:		Mother’s Email:
Mother’s Home Address (if different from child’s):

All medications are distributed by Camp Meds, which requires licensed prescriptions on file and an additional fee.

Emergency/Medical Information
Parent/Guardian Summer Phone:
Health Insurance Company:
Policy/Subscriber #:

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Summer 2012 EARLY Enrollment Dates & Fees

Valid through December 1, 2011

Session	Dates	Early Enrollment Fee	Full 2012 Fee
Full Season	June 24 – August 16	$8,600	$8,800
7-Week Session	June 24 – August 9	$7,600	$7,800
1st 4-Week Session	June 24 – July 19	$5,100	$5,400
2nd 4-Week Session	July 22 – August 16	$5,100	$5,400
Discovery Sessions	(1) June 24 – July 9 (2) June 22 – August 6	$3,100	$3,300
Toppers Sessions	(1) July 26 – August 6 (2) August 9 – August 16	$1,400	$1,500
Summit Program	August 2 – August 16	$2,000	$2,100

HORSEBACK RIDING LESSONS

The fee for riding lessons is $600 per 4-week session. Proper attire is required. Private board $500.00 per 4-week session. 1-week Toppers riding program is open to girls ages 9 to 13 only. English riding ability is required.

GOLF LESSONS

The fee for golf lessons (including course greens fees) is $600 per 4-week session. Proper attire required.

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Terms & Agreement

Telephone & Visitation Policy

Please note that your child may call home or receive calls from home twice each 4-week session, after the first 10 days of camp. Parents may visit once during the summer. Campers are not permitted to leave overnight with the exception of seven and eight week campers during the changeover weekend. Please refer to Parent Handbook 2012 for details. Visiting hours are between 9:00AM and 5:00PM. Several days are excluded due to special events, trips, etc.

Tuition

The tuition balance is due in full by May 1st, 2012. A 1.5% per month finance charge will be added to all overdue balances for each month after the due date. Please make checks payable to “Camp Nashoba North”. Please submit all payments in U.S. currency.

A 10% tuition reduction is available for the second and third sibling in your family providing all attend for 4 or more weeks. Tuition also includes laundry service, art supplies and most trips. Transportation is charged based on origin and destination. All luggage and bags must be shipped to camp prior to arrival of campers who are flying to camp domestically. Health insurance is not included. Linen rental is free of charge for international campers.

Deposit

A deposit of $1,000 is required with the application. This amount is credited toward the full tuition. If the camper withdraws prior to December 1, 2011 half of the deposit, $500 is refundable. No refunds will be given for late arrival or early departure from camp. Full balances are due May 1, 2012. Late fees will be administered. Any payments received after the due date shall forfeit any tuition discount offered. Tuition will automatically increase to the full amount. No refunds are given to cancellations after May 1, 2012. The directors reserve the right to withdraw or expel any camper whose influence, conduct, or actions are deemed harmful or disruptive to themselves or others, and will not or cannot abide by the rules and policies of camp. If this occurs, no deduction or return of fee, or any part thereof, will be made. Parent or guardian agrees to make necessary travel arrangements within 24 hours for the return of the child to their possession. During this period the child will not be allowed to participate in camp activities. Travel arrangements home and all associated travel expenses will be the responsibility of the parent or guardian. If necessary arrangements are not made, the camp will do so at the expense of the parent or guardian. Tuition fees are based on US cash prices.

Use or possession of cell phones, illegal drugs, tobacco, alcohol, fireworks, fighting or harassment, inappropriate language, any other dangerous items/conduct, or tampering with any fire-fighting/detection equipment is strictly prohibited and grounds for immediate dismissal without refund. We are committed to keeping Camp Nashoba® North safe and fun for everyone.

Authorization for Medical Treatment

I hereby give permission to medical personnel selected by the camp director to order x-rays, routine tests, treatment and necessary transportation for my child. In the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by the camp director to secure and administer treatment, including hospitalization for my child as named above. Health insurance is not provided by camp. Permission is given to use photographs or videos in which my child may appear.

Your child’s enrollment at Camp Nashoba® North represents your agreement to your child’s participation in camp activities, and acceptance of all benefits and risk of such activities, and I agree to release Camp Nashoba® North, Inc. from all claims resulting from the risks reasonably associated with camp activities. I have read and agree to the terms outlined on the pages herein.

A current physical examination form and medical health history are required of all campers and must be received via mail or fax no later than June 1, 2012. The parent/guardian and the physician must sign medical forms in order to attend camp. Proof of valid U.S. medical insurance is required.

Other Terms and Requirements

Uniforms are not required. However, we do request that each camper have at least two Camp Nashoba® North t-shirts, one camp sweatshirt, and a water bottle. Please refer to our Parent Handbook for proper clothing attire and appropriate Nashoba dress code guidelines.

For horseback riders, we believe that each child learning to safely ride horses should use proper riding clothes. An approved harness riding helmet, boots and breeches are required. Protective headgear must be worn at all times while on horseback and in lessons.

During the summer and throughout the rest of the year, Camp Nashoba® North staff takes photographs for several purposes such as yearbooks, brochures, videotapes, slideshows, and our web site. Your child may appear in photographs of this nature, and they may be used for camper use and/or advertising purposes. Our parent Facebook account will give you access to camper photos throughout the summer.

The Sebago Lake Region offers many fine restaurants and hotel accommodation for parents. Nashoba is a beautiful place and we encourage parents to visit with their children at camp and observe our programs and activities in progress. Neither campers nor Junior Counselors, under any circumstances, will be allowed to leave camp with relatives without the direct consent of a parent/guardian and the Nashoba directors. Seven and eight- week campers are permitted to leave camp overnight during the changeover weekend.

Jewelry is not allowed during most activities at camp for safety reasons. Cell phones, video cameras, DVD players, video iPods and other consumer electronics are not permitted. Digital cameras with movie capabilities are not permitted. All domestic transportation is escorted from the Portland International Jetport and all international flights are met at Boston’s Logan Airport. Detailed information and fees will be mailed to you upon enrollment. No bags or luggage will be transported to camp from the airport for domestic flights. By enrolling you agree to all guidelines in our Parent Handbook 2012.

Digital Signature

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