Child's Full Namechild Prefers to Be Called

Child's Full NameChild prefers to be called

Street Address City State

Zip/Postal Code CountryHome Phone #

Date of Birth (m/d/y)Age (as of June 2018)Sex (M/F)

School Grade Completed as of June 2018 Name of School

Child’s E-Mail Address How did you learn about us?

Former Summer Camp Experience, if any # years at Nashoba

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

* Sibling Discounts are available, please call for details.

Please indicate your attendance preferences:

 FULL SESSION (June 24 – Aug. 17) ...... $9,400

 1st SESSION (June 24 – July 20) . …………$6,800 2ndSESSION (July 22 – Aug. 17) . ………………$6,800

 JULY Option (June 24 – July 13) ………….$6,000  AUGUST Option (July 22 – Aug. 10). …………..$6,000

First Time Camper DISCOVERY & ROOKIE programs:For first-time campers completing grades 1 through 5. A fantastic opportunity to experience Nashoba for the first time! First Time Teens completing grades 6-8 check out 2nd Discovery Option. Enrollment comes with the option of extending your stay with an additional fee. All-inclusive tuition is $4,000. Space is very limited and campers may try this experience one time.

 Riding Program or  Golf Program

 1st Discovery Session (June 24 – July 6) Grades 1-5$4,000

 2nd Discovery Session (July 22– August 3) Grades 1-8$4,000 (teens welcome)

 Rookie Session (August 4-August 10) Grades 1-4 $1,900

TOPPERS RIDING PROGRAM: All-inclusive co-ed 1-week intensive horseback riding ages 9-14 Riding ability required.

 August 11 – August 17 Tuition $1,900

SUMMIT TEEN COMMUNITY SERVICE PROGRAM ages 16 & 17

 August 3 – August 17 Tuition $3,800

PARENT/GUARDIAN INFORMATION

Please include your surname preference (Ms., Mrs., Mr., Dr., etc.). Attach your business card if you desire. Please print clearly!

With whom does the child reside? Both Parents Father Mother

Who has legal custody? (if legally separated) Both Parents Father Mother

Name Relationship to Child

Work Phone Home Phone Cell Phone

E-Mail Address Occupation

*We send monthly newsletters and therefore ask that you provide at least one e-mail address.

Home Address (if different from child’s)

Name Relationship to Child

Work Phone Home Phone Cell Phone

Home Address (if different from child’s)

E-Mail Address______Occupation

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.:

~ Has your child had psychological counseling at anytime during the 2017-2018 school year? (Yes/No) ______If Yes, please explain:

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

~ Please note any special sensory or physical needs your child may have:

All medications are distributed by Andrew’s Pharmacy Camp-Pack Program (), which requires licensed prescriptions on file and an additional fee.

~ 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 seven and eight week campers during the changeover weekend. Please refer to Parent Handbook 2018 for details. Visiting hours are between 9:00AM and 5:00PM. Several days are excluded due to special events, packing, etc.

A deposit of $1,000 is required with the application. This amount is credited toward the full tuition. If the camper withdraws prior to December 1, 2017 half of the deposit, $500 is refundable. No refunds will be given for late arrival or early departure from camp. First Payment of $1,500.00 due February 1, 2018. Full Balance is due May 1, 2018. Late fees will be administered. A 1.5% per month finance charge will be added to all overdue balances for each month after the due date. Any payments received after the due date shall forfeit any tuition discount offered. Tuition will automatically increase to the full amount. No refunds are given to cancellations after February 1, 2018. The directors reserve the right to withdraw or expel any camper whose influence, conduct, or actions are deemed harmful or disruptive to themselves or others, and will not or cannot abide by the rules and policies of camp. If this occurs, no deduction or return of fee, or any part thereof, will be made. Parent or guardian agrees to make necessary travel arrangements within 24 hours for the return of the child to their possession. During this period the child will not be allowed to participate in camp activities or live with bunkmates. Travel arrangements home and all associated travel expenses will be the responsibility of the parent or guardian. If necessary arrangements are not made, the camp will do so at the expense of the parent or guardian. Use or possession of cell phones, illegal drugs, tobacco, alcohol, fireworks, fighting or harassment, inappropriate language, any other dangerous items/conduct, or tampering with any fire-fighting/detection equipment is strictly prohibited and grounds for immediate dismissal without refund. Campers must remain in cabin after Taps unless by direction of director. It is agreed that any dispute or cause of action arising between the parties, whether out of this agreement or otherwise, can only be brought in Cumberland County Superior Court located in Portland and shall be construed in accordance with the laws of the State of Maine. We are committed to keeping camp enjoyable for everyone.

Marketing and Media Disclaimer

​During the summer and throughout the rest of the year, Camp NashobaNorth 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 and 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 faxno later thanJune 1, 2018. 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: I , parent or guardian of , 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. These authorizations are limited to June 1 through August 31, 2018. Health insurance is not provided by camp. Permission is given to use photographs or videos in which my child may appear. 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 that could result in infections and various insect-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 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 have read and agree to the terms outlined on the pages herein.

Parent/Guardian Signature (Required): Date:

Cardholder's Name: Signature:

Card #: Expiration date (m/d/y):

Security Code (located on back of card):

Please note that credit card payment is only accepted for deposits. Tuition rates are stated in cash and U.S. check value.

6 and 7 week sessions are available by request

Special Options

HORSEBACK RIDING LESSONS

Riding lessonsis $600 per 4-week session. Shorter sessions are $150 per week.Proper attire is required. Private board $500.00 per 4-week session. 1-week Toppers riding program is open to boys and girls ages 9 to 14 and English riding ability is required.

GOLF LESSONS

Golf lessons (including course greens fees) is $600 per 4-week session. Proper attire required. Shorter sessions are $150 per week.

First time camper DISCOVERY & ROOKIE PROGRAMS

First-time campers completinggrade1 through 5 have 2 options. Teens completing grade 6,7 & 8 have one option. Rookie week is for campers who are completing grade 1-4 only. A fantastic one-time opportunity to experience Camp Nashoba North for the first time! Enrollment comes with option of extending your stay with additional fee. Due to the popularity of these program,spaces are very limited.

SUMMIT PROGRAM

Camp Nashoba North is proud to offer the Summit Program to 16 & 17 year old boys & girls that have completed grade 10 or 11. CNN’s Summit Program is committed to community service and is designed to encourage and support public service and stewardship in young people. It offers young men and women the opportunity to achieve at least 30 hours of team oriented community service while experiencing traditional camp living. Previous volunteer programs have included project work with organizations such as the Appalachian Mountain Club, Habitat for Humanity, Camp Sunshine, Partners for World Health and the Good Shepherd Food Bank. Participants take part in camp life and activities when in camp and are offered the opportunity take a leadership role in the development of one program activity.

A 10% tuition reduction is available for the second and third siblings in your family providing all attend for 4 or more weeks. Tuition includes laundry service, art supplies and most trips. All luggage and bags must be shipped to camp prior to arrival of campers who are flying to camp domestically. Health insurance is not included. Linen rental is free of charge for international campers.

A $1,000 deposit per child is due with the enrollment application. If the camper withdraws, half of the deposit, $500 is refundable if notification is received before December 1, 2017. No refunds or fee reductions will be made for early departures, late arrivals or cancellations. The Directors reserve the right to expel any camper whose influence, conduct or actions are deemed harmful or disruptive to themselves or others, and who will not or cannot abide by the rules and policies of Camp Nashoba North. If this occurs, no deduction or return of tuition fees, or any part thereof, will be made. Parents/guardians agree to make necessary travel arrangements within 24 hours for the return of the child into their possession. During this period the child will not be allowed to participate in camp activities. Travel arrangements home and all associated expenses are the responsibility of the parent/guardian. Ifnecessary arrangements are not made, the camp will do so at the expense of the parent/guardian.

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, 2018. The parent/guardian and the physician must sign medical forms in order to attend camp. Proof of valid U.S. medical insurance is required.

A $1,500.00 tuition payment for each child is due by February 1, 2018 and final balance is due IN FULL by May 1, 2018. A 1.5% per month finance charge will be added to all overdue balances for each month after the due date. No refunds are given after February 1, 2018. Please make checks payable to "Camp Nashoba North". Please submit all payments in U.S. currency. Please note tuition rates are stated in cash and U.S. check value. Credit card payment is only accepted for deposits. Final payment is through check or wire transfer.

Uniforms are not required. However, we do request that each camper have at least two Camp Nashoba North t-shirts, one camp sweatshirt, and a water bottle. Please refer to our Parent Handbook for proper clothing attire and appropriate Nashoba dress code guidelines.

Horseback riders: We believe that each child learning to safely ride horses should use proper riding clothes. An approved harness riding helmet, boots and breeches are required. Protective headgear must be worn at all times while on horseback and in certain horsemanship lessons.

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. Your child may appear in photographs of this nature, and they may be used for camper use and/or advertising purposes. Our private photo-sharing account will give you access to camper photos throughout the summer.

The Sebago Lake Region offers many fine restaurants and hotel accommodation for parents. Nashoba is a beautiful place and we encourage parents to visit with their children at camp and observe our programs and activities in progress. Neither campers nor Junior Counselors, under any circumstances, will be allowed to leave camp with relatives without the direct consent of a parent/guardian and the Nashoba directors. Seven and eight- week campers are permitted to leave camp overnight during the changeover weekend.

Jewelry is not allowed during most activities at camp for safety reasons. Cell phones, video cameras, DVD players, video iPods, any Internet access capable device and other consumer electronics are not permitted. Digital cameras are permitted, however movies may never be taken. E-Readers should remain at home.

All domestic transportation is escorted from the Portland International Jetport and allinternational flights are met at Boston's Logan Airport. Detailed information will be mailed to youupon enrollment. No bags or luggage will be transported to camp from the Portland Jetport for domestic flights.By enrolling you agree to all guidelines in our Parent Handbook.

We look forward to welcoming your child to an enriching camp experience this summer. Please call us with any questions.