2021 Session and Financial Agreement Form

Name of Participant:

Address:

Telephone: Cell Phone: Work Phone:

E-Mail: Fax:

Date of Birth:                 Age:

Social Security #                 T-Shirt Size:

Please put a check next to selected dates and fees as listed below:

Summer Sessions:  $3,000 per person per two-week session

Session I - June 27, 2021 to July 11, 2021
Session II - July 11, 2021 to July 25, 2021
Session III - July 25, 2021 to August 8, 2021
Session IV - August 8, 2021 to August 22, 2021

Fees:

Summer Camp Fee (Number of Sessions: x $3,000) = $
Transportation Fee (Optional) Transportation fee is $50 for transporting participant to OR from camp and $100 for transporting participant to AND from camp = $
Discount
5% discount for fees paid in full by March 15, 2021 =
$
SUMMER PROGRAM TOTAL DUE   =        $


DEPOSIT PAYABLE UPON REGISTRATION:

Summer Program
Number of Sessions: x $500.00 per two week session = $ Deposit

BALANCE DUE IN FULL BY MAY 15, 2021

Families will be notified by May 1, 2021 if camp cannot be operated safely and in accordance with state and local guideline because of COVID-19 concerns, and if so, all fees will be refunded. Fees less the deposit of $500 will also be refunded if a camper withdraws prior to May 1, 2021.

All fees must be paid prior to a participant's arrival. Fees will not be refunded if a participant arrives after the start of a session, withdraws after May 1, 2021 or is requested to leave because of behavior or health issues.

MEDICAL: Parent or guardians are responsible for all medical expense(s) of the camper.  Expenses for pre-existing condition(s) and medication(s) shall be pre-paid.  All medicines shall come with original prescription bottles.

Proof of vaccination against COVID-19 should be included with the medical information provided for a participant at the start of the participant's session. Camp Atlantic is authorized to seek medical care for the participant and to make medical decisions for the participant if I am not available.

MISCELLANEOUS: All clothing and personal items should have the participant’s name.


I HAVE READ AND AGREE TO COMPLY WITH THE CONDITIONS STATED ABOVE

Name (Parent/Guardian)
Date
Verification code:
Re-type verification code:
This is a security to check to ensure you are a human user.

 

 

Session and Financial Agreement Form