2008 Application for Enrollment

Parent/Guardian Names: (example: Sue and Jon Smith OR Sue Jones and Jon Smith)
Camper's Full Name:
Gender: Male   Female  
Age:
(as of day of arrival to camp)
Date of Birth:
(proper format: month/day/year xx/xx/xxxx)
Grade in Sept. 2008:
Campers entering grades 11 and 12 should apply as CIT’s		 3   4   5   6   7   8   9   10  
School Currently Attending:
Camper's T-shirt Size:


Camper's Home Address:
City:
State and/or Country:
ZipCode:
Home Phone:
Fax:
Email for Billing:


Mother's Name:
Mother's Occupation:
Mother's Business Phone:
Mother's Cell Phone:


Father's Name:
Father's Occupation:
Father's Business Phone:
Father's Cell Phone:


If divorced in custody of:

How many years has your child attended Camp Waziyatah? 0  1  2  3  4  5  6  7  8 
How did your family FIRST hear about Camp Waziyatah?

All campers may enroll for:

First Session $4250 (Sunday , June 29 - Thursday, July 24)
Second Session $3450 (Sunday, July 27 - Friday, August 15)
Full Session (both sessions) $7700 (Sunday , June 29 - Friday, August 15)

Campers 8-13 years old may also choose to enroll for:

First Two Weeks $2400 (Sunday, June 29 - Saturday, July 12)
Second Two Weeks $2400 (Sunday, July 27 - Saturday, August 9)

Campers enrolled for both first and second sessions may arrange to spend time away from camp with family or friends between sessions; or they may sign up for the 7-weekers-only Trip:

7-weekers Trip (Thursday, July 24 - Sunday, July 27)



OPTIONS


Whitewater Rafting - $175 per camper

Bus Travel - Airport to Camp - $40

Bus Travel - Camp to Airport - $40

Capital Improvement Fund - Make a Donation     (amount)
    (suggestion: $100 - please note that horseback riding is free this year)



Cabin Mate Request
(one name only please)
Sibling Name(s) and Age(s)
Any behavioral or social problems at home, school, or a past camp that we ought to be aware of?
Any medical problems? What prescribed medications, if any, is your camper taking regularly?


TUITION INCLUDES:

General camp fee includes room and board, supervision, instruction, arts materials, most day and overnight camping trips, routine medical nursing care at Camp, and laundry.


NOT INCLUDED IN TUITION:

Doctors' visits, hospital services, medicines and/or medical treatment, personal care items, postage or UPS charges for items left at Camp, or things the family wishes to have shipped. The contingency account covers these costs. Any balance remaining in the contingency account will be refunded in September, unless you choose to make a tax deductible donation of the balance to the American Camp Association.

Transportation to and from Portland International Airport, and the whitewater rafting trip are prepaid separately. Sign-up forms will arrive in the spring information packet.


PAYMENT INFORMATION

Payment: A $1,000 non-refundable deposit is necessary to reserve a place at camp.

 

Upon receipt of your application, you will be emailed your invoice to the “Email for Billing” address you provided above. Camper’s place at camp will not be held until he or she is accepted and the deposit is paid.

 

Payments may be made by check, Visa or MasterCard.

 

For payments by credit card, please call the camp office (Until June 7th) 310-379-CAMP (2267) or (After June 7th) 207-583-CAMP (2267) once you have submitted this application.

 

For payments by check, please promptly mail it to the camp office once you have completed the application.

 

(If mailed before June 1st)
P.O. Box 3173
Manhattan Beach, CA 90266

 

(If mailed after June 1st)
530 Mill Hill Rd.
Waterford, ME 04088


Please indicate which method of payment your will use: Check     Credit Card

 



Terms of Agreement: I am the applicant's parent or legal guardian. I understand and agree that the directors reserve the right to refuse admission to, or request withdrawal of any Camper as they deem necessary. I understand and agree that the use, possession of, or association with tobacco, alcohol, or illegal drugs, or any behavior which, in the opinion of Camp officials, violates any criminal statute of the State of Maine or the customs, rules or regulations of the Camp, is cause for dismissal.

 

I understand and agree that there is no tuition reduction for late arrival, nor is there tuition refund for early departure or for dismissal.

 

I understand and agree that Camp is not responsible for lost or damaged personal property, nor for campers' medical expenses, and that it is my responsibility to insure against these expenses.

 

I agree to abide by the Camp policies including those regarding items to leave home, visits, telephone calls, cabin placements, and package contents. I grant permission to have my child's address given to other campers. Camp Waziyatah may use photographs and video footage of my child on the website and for publicity purposes.

 

In the event I cannot be reached in an emergency while my child is under Camp supervision, I hereby give permission to the physician selected by the Camp directors to hospitalize, administer proper treatment, and order injections, anesthesia, or surgery for my child. I attest that I will fully disclose any and all medical and/or psychological conditions which my child may have.

 

I also recognize that participation in any Camp activity may involve a degree of risk; I have discussed with my child the risks involved, and I expressly authorize my child's participation in all Camp activities, except as noted on this registration.

 

Privacy Policy: Camp Waziytah LLC does not share information with third parties for any reason. This information is for internal use only and may be shared with the camper's counselors and/or camp nurses and is otherwise considered confidential.


Your Comments:

Check this box if you accept the terms of this agreement.



Payment Schedule

Payment by check drawn on a US bank or Credit Card (Visa, MasterCard, Discover)
  • Due with this application - $1000 non-refundable deposit (holds camper�s place at camp)
  • Camp Waziyatah will bill $1000 monthly until balance paid
  • May 1 - Balance due including contingency amount ($100 per camper per session U.S campers - $500 per session international)
  • Pay in full with this application and save $100 (Before March 1 only) - remove from full amount


Payment Options (Choose One)

Pay by Check
Pay by Credit Card

Cardholder Name (Print Clearly)
Card Number
Expiration Date (MM/YY)
Card ID # (Three numbers after signature line on back of card)


   
 
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