Concord Academy Summer Camp 2010 Traditional Programs

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Registration Form 2010
_________________________________________________________________

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.

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
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. 2010)
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

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.

	Pre-Camp June 21-25	Week 1 June 28- July 2	Week 2 July 6-9*	Week 3 July 12-16	Week 4 July 19-23	Week 5 July 26-30	Week 6 August 2-6	Week 7 August 9-13	Teen Wilderness Aug. 16-20
Kiddie Camp	$375 Intro	$375	$315	$375	$375	$375	$375	$375
Day Camp		$550	$475	$550	$550	$550	$550	$550
Junior Adventurers NEW		$650	$575	$650	$650	$650	$650	$650
Teen Adventure Camp NEW age group		$1450 Air and Sea Adventures		See Comm Service	$1450 Land Adventures		$1450 Local Sports and Attractions		See Teen Wilderness
C.I.T.			$880
ACADEMIC CAMPS	$575 MovieMakers	$575 MovieMakers	$500 Digital Story Telling	$575 Digital Story Telling	$300 Writing Camp 9am-12:30pm	$575 Architecture Camp	$300 Writing Camp 9am-12:30pm
SPORTS CAMPS	$550 Courts and Fields	$550 Field Hockey	$475 All-Sports	$550 Baseball Camp	$550 Flag Football	$550 Boys Lacrosse	$550 Girls Lacrosse	$550 Soccer Camp
Tennis Camp	See above	$575	$500	$575	$575	$575	$575	$575
MINI SPORTS 9:30-10:30am NEW				$150 Mini Sluggers		$150 Mini Laxers		$150 Mini Kickers
ARTS CAMPS				$550 Art Camp	$550 Woodshop Camp	$1100 Drama Camp		$550 Woodshop
ARTS CAMPS				$550 Art Camp	$550 Woodshop Camp		$550 Adv. Dance	$550 Dance Camp
Circus Arts	$600	$600	$525	$600	$600	$600 Aerial Dance	$600 Tumbling	$600
Kung Fu Camp				$600				$600
Addional Teen Camps				$900 Community Service					$1000 Teen Wilderness
BUILD-IT-YOURSELF	$575 Robots with an Attitude	$1150 Internship		$575 Soap Box Derby	$575 Robots that Earn Money (LEGO 101)	$575 Advanced Robotics Chain Reaction	$575 Digital Music	$575 Computer Game Design
BUILD-IT-YOURSELF	$575 Robots with an Attitude		$500 So you want to be a Builder	$575 Soap Box Derby	$575 Robots that Earn Money (LEGO 101)	$575 Advanced Robotics Chain Reaction	$575 Digital Music	$575 Computer Game Design

* There will be no camp Monday, July 5, 2010. All one week camps have been pro-rated.



Transportation Registration:	Please check desired Bus Route, indicate stop, and check: AM only, PM only, Round-Trip
Bus Route 1:	Bus Route 2:	Bus Route 3:
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	Newton: Simply Circus Waltham: Alphagraphics Weston: Cedar Hill Dairy Joy
AM Only PM Only Round Trip
One-Way (AM or PM): $60/week \| Round-Trip: $100/week
Financial Aid I would like to donate one week of camp= $550 I would like to donate one day of camp= $110 Other Donation amount: $ No Donation to the Concord Academy Summer Camp Scholarship Fund. Thank you!

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, 2010. Payment in full must accompany applications filed after May 1, 2010.

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, 2010 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, 2010.

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 Monday, July 5, 2010.

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.

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