2020 Enrollment Test - Camp Nashoba North

Child's Full Name

Child's Full Name*

First Last

Child Prefers to Be Called

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Do you have a US or International Phone Number*

Home Phone Number*

Date of Birth*

Gender - Identifies As*

Male
Female

School Grade Completed (as of June 2021)*

Name of School*

Child's Email Address

How did you learn about us?

Former Summer Camp Experience, if any

Number of Years at Nashoba

Optional: Please select ONE bunkmate with whom you’d like to be placed:

Sessions & Programs

Sibling Discounts are available, please call for details.

Please indicate the session or session(s) you would like to attend:*

FULL SESSION (June 27 – Aug. 14) - $10,500
1st SESSION (June 27 – July 22) - $7,300
2nd SESSION (July 25– Aug. 14) - $6,400
1st Discovery Session - Grades 1-5 (June 27 – July 10) - $4,600
2nd Discovery Session - Grades 1-5 (July 25– August 7) - $4,600
Toppers Riding Program - Ages 9-14 (June 27-July3) - $2,300
Summit Teen Leaders 1 Ages 16 & 17 (June 27-July 22) - $7,600
Summit Teen Leaders 2 Ages 16 & 17 (July 25-Aug 14) - $6,400

Electives

Parent/Guardian Information

With whom does the child reside?*

Both Parents
Father
Mother

Who has legal custody? (if legally separated)

Both Parents
Father
Mother

Parent 1's Name*

Prefix First Last

Parent/Guardian 1's Relationship to Child*

Do you have a US or International Phone Number*

Parent/Guardian 1's Cell Phone*

Parent/Guardian 1's Home Phone*

Parent/Guardian 1's Work Phone*

Parent/Guardian 1's Cell Phone*

Parent/Guardian 1's Home Phone*

Parent/Guardian 1's Work Phone*

Parent/Guardian 1's E-mail Address*

Parent/Guardian 1's Occupation*

Parent/Guardian 1's Home Address (if different from child’s)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Parent/Guardian 2's Name

Prefix First Last

Parent/Guardian 2's Relationship to Child

Do you have a US or International Phone Number

Parent/Guardian 2's Cell Phone

Parent/Guardian 2's Home Phone

Parent/Guardian 2's Work Phone

Parent/Guardian 2's Cell Phone

Parent/Guardian 2's Home Phone

Parent/Guardian 2's Work Phone

Parent/Guardian 2's E-mail Address

Parent/Guardian 2's Occupation

Parent/Guardian 2's Home Address (if different from child’s)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Camper Health

Health Insurance Company

Policy/Subscriber #

Please note any special issues or concerns that might affect your child's adjustment at camp, i.e. divorce or separation, school, peers, etc.:

Does your child have any physical or mental health issues that we need to be aware of in order to make necessary accommodations? Please understand that full disclosure of this information is necessary in order for your child to have a successful summer so that we can make reasonable accommodations.

Please note if your child has any dietary needs, i.e. lactose intolerant, vegetarian, etc.:

Has your child ever been known to sleepwalk? If yes, please describe:

What specific skills would you like your child to improve while at camp this summer? In what camp activities is your child most interested?

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 eight week campers during the changeover weekend. Please refer to Parent Handbook 2021 for details. Visiting hours are between 9:00AM and 5:00PM. Several days are excluded due to special events and packing.

Deposit & Payment Terms

(a) $1,500 deposit per child is due with the enrollment application and is credited toward the full tuition when Camp Nashoba North accepts your child’s enrollment. $2,500.00 due February 1, 2021. Remaining Balance is due April 1, 2021. Enrollments may be cancelled with written notice through March 1, 2021 for a full refund less any credit card or bank transfer fee. After March 1, 2021, no payments will be refunded unless we are able to immediately fill that spot from a waitlist. Payments are non-transferable. Regardless of payment method, no adjustments, credits, allowances or refunds will be made for late arrival, early withdrawal, early termination of camp operations, or dismissal of Camper. It is strongly recommended that Parent purchase camp travel insurance at https://www.aplusplans.com to protect their investment in their camper’s summer camp experience. Refund checks/credits are issued in September. (b) Limited right to refund. If camp operations are cancelled before the date scheduled for the start of the camp season (the “Opening Day”), then Parent shall be entitled to a full refund of all payments made or a credit towards next year’s camp enrollment for the same camper (a Credit). Camp operations may be cancelled in the following circumstances: (i) in the event Camp, in its sole discretion, determines for health or safety reasons that camp operations cannot be safely opened, or if (ii) cancellation is required due to circumstances beyond the control of the Camp, including without limitation, natural disaster, weather, floods, utility failures, inaccessibility, pandemics, communicable disease (including without limitation COVID-19 or other infectious agent –whether or not the possibility shall be foreseeable), civil unrest, government law, order, rule, regulation, mandate, quarantine restrictions, or any similar requirement. Prior to Opening Day, Camp reserves the right to alter the dates of camp season and in the event such alteration reduces the number of days in camp season, Camp may make an equitable adjustment (or credit), as determined by it, for payments made.

Marketing & Media Disclaimer

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. I grant permission for my child’s image to be used for camp use and/or promotional purposes. Our private photo-sharing account will give you access to camper photos throughout the summer.

Physical Exam & Medical Insurance Policy

A current physical examination form and medical health history are required of all campers and must be received via mail, email, or fax no later than June 1, 2021. The parent/guardian and the physician must sign medical forms in order to attend camp. Proof of valid U.S. medical insurance is required.

Authorization for Medical Treatment & Assumption of Risk

I, parent or guardian of the aforementioned camper, authorize any physician, nurse or other health care provider, to communicate with the medical staff and director of Camp Nashoba North, or his/her designee, about my child’s medical condition, treatment, and/or prognosis. We further authorize the camp medical staff to discuss any medical conditions with the director, his/her designee, or the child's counselor when the medical staff, in its sole discretion, believes such communication to be in the best interest of the child. In the event I cannot be reached in an emergency when my child in Camp Nashoba North supervision, I hereby give permission to the physician selected by the Camp Nashoba North director to hospitalize, secure proper treatment for, and or order medications, injections, anesthesia, or surgery for my child. These authorizations are limited to June 1 through August 31, 2021. Health insurance is not provided by camp. 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. I understand that part of the camping experience involves activities and group interactions that may be new to my child, and that they come with uncertainties beyond what my child may be used to dealing with at home. Such risks include uneven terrain, standing and moving water, forested and other areas that may result in wildlife encounters including mammals, reptiles and insects and arachnids that could result in infections and various insect-or arachnid-transmitted diseases. I am also aware that my child may participate in off-campus activities such as hiking and athletic competitions that involve additional risks. In addition, there are certain unavoidable risks associated with various games and play activities such as collisions, wayward objects such as balls and other equipment and other risks. I recognize that Camp Nashoba North cannot guarantee that it is free from COVID 19, other pathogens and communicable diseases, and that as in any facility there is a risk of becoming ill. I am aware of these risks, and I am assuming them on behalf of my child. I realize that no environment is risk-free, and so I have instructed my child on the importance of abiding by the camp’s rules, and my child and I both agree that he or she is familiar with these rules and will follow them. I agree to release Camp Nashoba® North, Inc. from all claims resulting from the risks reasonably associated with camp activities.

I accept the Telephone & Visitation Policy, Deposit & Payment Terms, Marketing & Media Disclaimer, Physical Exam & Medical Insurance Policy and Authorization for Medical Treatment & Assumption of Risk Statements as a condition of my child's enrollment at Nashoba North*

Check Here to Accept

Camp Nashoba North accepts check, cash, wire transfer and credit cards. A 3% credit card transaction fee will be assessed on all payments after deposit. The credit card transaction fee is waived for all payments prior to January 1, 2021. Tuition rates are stated in cash and U.S. check value.

Deposit

Deposit Amount:*

Price: $1,500.00

Give the Gift of Camp

Please consider a donation to our campership program.

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Billing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Total

$0.00

Signature*

Comments

This field is for validation purposes and should be left unchanged.