* indicates a required field
Specific weeks can be adjusted through the start of camp.
(Includes Transportation, Hot Lunch, After Care, Group Picture, T-Shirt, and Backpack)
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:*
3. Name of school entering Sept. 2018:*
4. Two campers your child would like to be grouped with:
5. Health comments & history(allergies, asthma, medications, limitations, dietary restrictions, etc.
6. Additional information you feel would be helpful regarding your child's adjustment:
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).
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 onApril 1st.
Please charge my credit card the full amount now.
If you have any questions, please contact us at 845-352-3521 or firstname.lastname@example.org.
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*: