Enriching the Lives of Children... One Camper at a Time
Blue Rill Day Camp
Blue Rill Day Camp

2018 Summer Enrollment Application

* indicates a required field

CAMPER DETAILS

Name of Camper:*
Gender:* Male     Female
Date of Birth:*
Age as of 6/25/18:*
Grade as of 9/18:*
Choose Weeks:* 2 Weeks 3 Weeks 4 Weeks 5 Weeks 6 Weeks 7 Weeks 8 Weeks
MINI-DAY PROGRAM
      9AM - 2PM (Optional for children entering kindergarten or below)
COUNSELOR-IN-TRAINING PROGRAM
      Leadership training for campers entering 10th grade in 9/18

2018 SUMMER DATES (INDICATE THE WEEKS ATTENDING*)

Specific weeks can be adjusted through the start of camp.


Week 1
6/25-6/29

Week 2
7/2-7/6*

Week 3
7/9-7/13

Week 4
7/16-7/20

Week 5
7/23-7/27

Week 6
7/30-8/3

Week 7
8/6-8/10

Week 8
8/13-8/17

*no camp on Wednesday 7/4

PARENT 1 INFORMATION

Relation to Camper:* Mother     Father
Salutation:* Mr.     Mrs.     Ms.     Dr.
Last Name:*
First Name:*
Address:*
City:*
State:*
Zip:*
Home Phone:
Cell Phone:*
Business Phone:
Email:*

PARENT 2 INFORMATION

Relation to Camper: Mother     Father
Salutation: Mr.     Mrs.     Ms.     Dr.
Last Name:
First Name:
Address:
City:
State:
Zip:
Home Phone:
Cell Phone:
Business Phone:
Email:

2018 SUMMER TUITION RATES

(Includes Transportation, Hot Lunch, After Care, Group Picture, T-Shirt, and Backpack)

FULL DAY SESSIONS: MONDAY - FRIDAY / 9 AM - 4 PM
Campers entering kindergarten or below

2 WEEKS
$2195
3 WEEKS
$3295
4 WEEKS
$3895
5 WEEKS
$4995
6 WEEKS
$5895
7 WEEKS
$6195
8 WEEKS
$6495

FULL DAY SESSIONS: MONDAY - FRIDAY / 9 AM - 4 PM
Campers entering grades 1-9

2 WEEKS
$2395
3 WEEKS
$3595
4 WEEKS
$4395
5 WEEKS
$5495
6 WEEKS
$6595
7 WEEKS
$6995
8 WEEKS
$7295

MINI DAY SESSIONS: MONDAY - FRIDAY / 9 AM - 2 PM

2 WEEKS
$1995
3 WEEKS
$2895
4 WEEKS
$3495
5 WEEKS
$4595
6 WEEKS
$5295
7 WEEKS
$5495
8 WEEKS
$5695

CIT PROGRAM: MONDAY - FRIDAY / 9 AM - 4 PM

4 WEEKS
$3295
5 WEEKS
$4195
6 WEEKS
$5095
7 WEEKS
$5295
8 WEEKS
$5495

DISCOUNTS:

  • Siblings: 1st sibling = 5% off, 2nd sibling = 10% off, 3rd sibling = 25% off
  • In addition to these discounts, once enrolled, BRDC families receive a $250 credit for every new family who enrolls based on their referral.

CAMPER INFORMATION

1. T-shirt size:*
Youth: S (6-8) M (10-12) L (14-16)
Adult: S M L XL

2. I give permission to share my contact information with campers in my child's group:*
YES NO

3. Name of school entering Sept. 2018:*

4. Two campers your child would like to be grouped with:
(1)
(2)

5. Health comments & history
(allergies, asthma, medications, limitations, dietary restrictions, etc.

6. Additional information you feel would be helpful regarding your child's adjustment:


REFERRAL INFORMATION

Please list any other families you think would like to receive information from us for next summer (You will receive $250 tuition credit for each new family enrolled for Summer 2018).

Family name:
E-mail:
Address:
Family name:
E-mail:
Address:

TRANSPORTATION INFORMATION

Indicate any special transportation concerns or if pick-up / drop-off address will be different than home:

SUMMER 2018 PAYMENTS

To submit an online payment by credit card, please mark one of the below options:

Charge $1000 (per camper) now. Blue Rill should then divide the remaining balance evenly through June 2018.

Charge $1000 (per camper) now. Blue Rill should then charge the remaining balance on
April 1st.

Please charge my credit card the full amount now.

Card Type: Amex     Visa     MasterCard     Discover
Name on Card:
Card Number:
Billing Address:
(if different than above)
Exp. Date:
Security Code:

If you have any questions, please contact us at 845-352-3521 or don@bluerilldaycamp.com.


PARENTAL AUTHORIZATION - MUST BE SIGNED

1. I hereby give permission to the medical personnel selected by Blue Rill Day Camp to provide routine health care and treatment; to administer medications; to release any records necessary for insurance purposes; and to provide or arrange necessary transportation. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by Blue Rill Day Camp to render whatever treatment he/she deems necessary and/or secure and administer treatment, including hospitalization for the camper named above.

2. Permission is hereby granted for photographs and videos to be taken of my child during Blue Rill Day Camp activities, and Blue Rill has the right to utilize these photographs and videos in camp promotional and display materials.

3. Permission is hereby granted to Blue Rill Day Camp for my son or daughter to participate in all activities and events, and to take my child on trips outside of camp as part of the regular camp program. Permission is also granted for my child to swim at off premises swim facilities that are part of our travel program.

4. I understand that all payments made to Blue Rill are refundable in full before March 1, 2018.

ELECTRONIC SIGNATURE OF PARENT OR GUARDIAN*:
DATE*:

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