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
$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
$500 So you want to be a Builder

* 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.


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