Camp Registration Form 2011/2012

Thank you for your interest in our camp.

Please, fill out one form per child and submit at the end of the form. You will receive an email after submitting.

Sincerely,

Efgb Camp Team

STUDENT INFORMATION

First Name : *

Last Name : *

EFGB Summer Camp Session: : *

Camp d'Hiver - "Un Pays Un Jour": Feb 20 to Feb 24 - Half Day (9:00am to 13:00pm) - Fee: $250

Camp d'Hiver - "Un Pays Un Jour": Feb 20 to Feb 24 - Half Day (13:00pm to 17:00pm) - Fee: $250

Camp d'Hiver - "Un Pays Un Jour": Feb 20 to Feb 24 - Full Day (9:00am to 17:00pm)- Fee: $390

Date of Birth : *

Gender : *

Current efgb student : *

Current Grade : *

Address

Street : *

City : *

State : *

ZipCode : *

GUARDIANS

Guardian 1:

First Name : *

Last Name : *

Home Email : *

Work Email :

Phone Numbers

Home: : *

Cellphone: :

Work: :

Guardian 2

First Name :

Last Name :

Home Email :

Work Email :

Phone Numbers

Cellphone: :

Work: :

Home: :

PICK UP PROCESS

A parent or guardian must authorize up to three individuals to pick-up their camper. Authorized individuals will be required to present valid identification to pick-up any child from camp.
I authorize the following individuals to pick-up my camper:

1st Person: :

First Name/ Last Name/ Tel #

3rd Person: :

First Name/ Last Name/ Tel #

2d Person: :

First Name/ Last Name/ Tel #

FINANCIAL AGREEMENT

- An extra-$25 applies to non-EFGB members per week.
- Camp tuition must be paid once registered by check only made to efgb and mailed to efgb, 223 East St, Lexington MA 02420.
- Should no remaining spots be available, we will hold your check and put you on a waiting list.Check will be returned if child does not participate in camp due to lack of spots.
- A $10 late fee will be charged for each 10 minute increment or part of 10 minute increment past the scheduled pick-up time.
- A late fee of $25 will be applied to payments received 10 days after the due date, $50 after 20 days. Any check returned by the bank will be subject to a $35 processing fee.

CANCELLATIONS AND REFUNDS
- Cancellations made one month before the starting date will ensure a full refund of camp tuition.
- Cancellations made one month after the starting date will not be eligible for a refund.
- If a camper is unable to attend all sessions of camp for any reason, the camper will not receive a refund.There will be no replacements, substitutions or credits for single days missed.

Date : *

Signature (First/Last Name) : *

MEDICAL INFORMATION

Food allergies :

Allergies to medications :

Asthma : *

Requires inhaler : *

Contact in case of an emergency: Name and telephone number : *

Name and telephone number of doctor in case of emergency : *

MEDICAL RELEASE:

I hereby authorize emergency medical care for my child. If, in the judgment of the staff, treatment is required for an injury or illness, I hereby also authorize the administering of anesthetics and recourse to other procedures deemed necessary by the attending physician. I understand that whenever possible I will be notified prior to medical treatment of my child, or at the earliest possible time should prior notice prove impossible. I am financially responsible for expenses medical care or transportation incurred.

Date : *

Signature (First/Last Name) : *

OTHER AGREEMENT

AGREE TO HOLD HARMLESS AGREEMENT:

I agree to hold abide by the conditions herein and agree to hold harmless, waive and release any and all rights to claims for damages against efgb, its agents and employees who may have been involved in the planning and implementation of this program.

EXCLUSION:

efgb reserves the right to exclude on a temporary or permanent basis any child whose behavior in class has a negative impact on other children or the overall performance of the class. Fees will be reimbursed on a pro-rate basis with a minimum charge of $200.

Date : *

Signature (First/Last Name) : *

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