Registration Form 2012

Please fill out one form per child - if you have multiple children, please complete and submit the first child,
then press your browers "back" button and change the campers information.

If you prefer to mail your registration:

Download the 2012 Camp Registration form (PDF) HERE

Download the new 2012 brochure (PDF) HERE (14 megs)

We are a... New Family Returning Family

	Parent / Guardian (1)
Name
Home Phone
Work Phone
Cell Phone
Email
Address
City
State	Zip

	Parent / Guardian (2)
Name
Home Phone
Work Phone
Cell Phone
Email
Address (if different)
City
State	Zip

I first heard about Concord Academy Summer Camp from:
Friend Web Site Camp Fair Newspaper Internet Search
Other

Have any of your family members attended Concord Academy for School? Yes (Name: ) No

Emergency Contact (other than parent/guardian)
Name
Relationship to Camper
Home Phone
Work Phone
Cell Phone

	Camper
First Name
Last Name
	Boy Girl
Date of Birth
Entering Grade (Sept. 2012)
T-Shirt Size	Child SM Child M Child L Adult S Adult M Adult L Adult XL
Friendship Request(s)

Transportation
Names of people (other than GUARDIANS listed above) authorized to pick up my child(ren)



It is OK to share my name and phone number for carpooling purposes:	Yes No

	Week 1 June 25 - 29	Week 2 July 2 - 6*	Week 3 July 9 - 13	Week 4 July 16 - 20	Week 5 July 23 - 27	Week 6 July 30 - August 3	Week 7 August 6 - 10	Week 8 August 13 - 17
KIDDIE CAMP	$420	$350	$420	$420	$420	$420	$420	$420
DAY CAMP	$610	$490	$610	$610	$610	$610	$610	$610
JR ADVENTURERS	$725	$600	$725	$725	$725	$725	$725	$725
TEEN ADVENTURE CAMP	$1600 Air and Sea Adventures		$725 Community Service	$1600 Land Adventures		$725 Community Services	$1600 Local Sports and Attractions
Counselor - in - Training (C.I.T.)			$1050
ACADEMIC CAMPS	$640 Full-Day Writing	$280 Half-Day Writing	$640 Digital Storytelling	$640 Full-Day Writing	$350 Half-Day Writing	$640 Music Technology Level 1	$640 Music Technology Level 1	$640 Music Technology Level 2
SPORTS CAMPS	$610 Courts and Fields	$490 All Sports	$610 Baseball	$610 Soccer	$610 Girls Lacrosse	$610 Boys Lacrosse	$610 Flag Football	$610 Soccer
TENNIS CAMP Full Day Half & Half	See Above	$490	$610	$610	$610	$610	$610	$610
MINI SPORTS 9:30-10:30 am			$150 Mini Sluggers	$150 Mini Laxers		$150 Mini Laxers		$150 Mini Kickers
ARTS CAMPS	$610 Woodshop Camp		$610 Songwriting Camp	$610 Clay Camp	$610 Woodshop Camp	$1220 Drama Camp		$610 Show Time
ARTS CAMPS	$610 Woodshop Camp		$610 Songwriting Camp	$610 Clay Camp	$610 Woodshop Camp	$610 Dance Camp	$610 Adv. Dance	$610 Art Camp
CIRCUS ARTS	$690	$560	$690	$690	$690	$690	$690	$690
KUNG FU CAMP	$610			$610				$610
BUILD - IT - YOURSELF	$640 LEGO Candy Machines	$515 Flying Machines	$640 Intro to Architecture	$640 LEGO Robots that Earn Money	$640 Scratch Cuckoo Clocks	$640 Web Site Design Workshop	$640 LEGO Robotic Super Heroes	$640 Soap Box Derby
BUILD - IT - YOURSELF	$640 Graphics & Animation	$515 Flying Machines	$640 Scratch Comp Games	$640 LEGO Robots that Earn Money	$640 Scratch Cuckoo Clocks	$640 Web Site Design Workshop	$640 LEGO Robotic Super Heroes	$640 3D Computer Graphics

* There will be no camp on Wednesday, July 4, 2012. All one week camps have been pro-rated.

Extended Day (AM and/or PM) is available on a daily or weekly basis. Registration form will be mailed to familes in early Spring.

Transportation Registration: Please check desired Bus Route, indicate stop, and check: AM only, PM only, Round-Trip
Bus Route 1:	Bus Route 2:
Cambridge: Russell Athletic Complex Arlington: Gibbs Center Parking Lot Arlington: St. Athanasius Church parking lot Lexington: Lexington high School	Wayland: Wayland Public Library Sudbury: Noyes Elementary School Maynard: Welcome to Maynard “turnaround” Acton: Buscemi’s Town Line Convenience Acton: Acton Bowladrome
AM Only PM Only Round Trip
One-Way (AM or PM): $60/week \| Round-Trip: $100/week
Financial Aid Half-Day of Camp $61.00 USD 1 Day of Camp $122.00 USD 2 Days of Camp $244.00 USD 1 Week of Camp $610.00 USD to the Concord Academy Summer Camp Scholarship Fund. Thank you!

During the camp season, staff members and/or professional photographers take photos for marketing purposes, which may include the child(ren) listed on this registration form. Parents/guardians may refuse any or all commercial use of these photos related to specific campers, provided that a written request is received by the camp director prior to the start of camp. Please include a current photograph of your child with the written request, so we can make certain their photo is not used for marketing purposes.

Please send in a check for $50 per camper per week, plus all transportation fees, to:
Concord Academy Summer Camp
166 Main Street
Concord, MA 01742.

The balance is due and payable on or before May 1, 2012. Payment in full must accompany applications filed after May 1, 2012.

Registration Agreement: By clicking below, I certify that I have read, understand, and agree to all Registration and Cancellation/Change Policies.

I understand that the balance is due on or before May 1, 2012 and if balance is not paid, camper’s registration will be canceled.

I understand my child may not attend camp unless my child’s physician and I complete a Health Form prior to June 1, 2012.

I understand that the Camp Director has the right to dismiss a camper, when in their judgment the camper’s behavior interferes with the
safety or rights of others, the group, or the rules of conduct established by Concord Academy Summer Camp.

I give my son/daughter permission to engage in all Concord Academy Summer Camp programs, activities, and events,
including off-site trips by CA or commercial transportation. I understand there is NO CAMP on Wednesday, July 4, 2012.

All Concord Academy Summer Camp programs, as well as transportation routes, have a minimum enrollment requirement.
Concord Academy Summer Camp reserves the right to cancel any program due to low enrollment.

To download CASC's Health Form and additional Forms, please click on "Parents Page"

Type in captcha before you agree

166 Main Street, Concord MA, 01742 | Phone: (978) 402-2284 | camp@concordacademy.org