2009 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  
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  9  10 
How did your family FIRST hear about Camp Waziyatah?

All campers may enroll for:

First Session $4675 (Sunday , June 28 - Thursday, July 23)
Second Session $4675 (Sunday, July 26 - Thursday, August 20)
Full Session (both sessions) $8450 (Sunday , June 28 - Thursday, August 20)

Campers 7-11 years old may also choose to enroll for:

First Two Weeks (ages 7-11) $2650 (Sunday, June 28 - Saturday, July 11)
Second Two Weeks $2650 (Sunday, July 26 - Saturday, August 8)

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 Full Session/Changover Trip:

Full Session/Changover Trip (Thursday, July 23 - Sunday, July 26 )

Early bird discounts: (***RC, This section will need to be removed on October 1st)
If deposit paid before September 30th:
1st or 2nd session discount is $425 (total amount of $4250, equal to last year’s tuition)
1st or 2nd two week session discount is $250 (total amount of $2400, equal to last year’s tuition)
Six week session discount is $600 (total amount of $6325)
Full session discount is $750 (total amount of $7700, equal to last year’s tuition)

Contingency Account: All parents or guardians will be invoiced $100 for the contingency account which will be used to cover incidentals, like shipping items home or a trip to the dentist. Campers can use up to $50 for personal items (like tee-shirts), while the remaining $50 will be reserved for necessities (like a toothbrush or rain poncho) or incidentals. Remaining amounts from this account will be returned to families after camp.

Help someone less fortunate: Check here to donate the remaining amount of your contingency account to the Camp Waziyatah Scholarship Fund)



OPTIONS


Whitewater Rafting (for campers 12 and older only - campers entering 9th and 10th grades have a special rafting trip only for them) - $175 per camper

Bus Travel to Camp from Portland Airport - $50

Bus Travel from Camp to Portland Airport - $50

Bus Travel to Camp from Boston Logan Airport - $100

Bus Travel from Camp to Boston Logan Airport - $100

Capital Improvement Fund - Make a Donation     (amount)

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



Cabin Mate Request
(one name only please)
Sibling Name(s) and Age(s)
Your Comments:


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.

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 to give us your card information (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 you 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.

 

I agree that this agreement will be governed by and construed in accordance with the laws of the state of Maine. I submit to the exclusive jurisdiction of any court of the state of Maine located in the county of Oxford for the purpose of any suit, action, or other proceeding. I agree that if I take any legal action against Camp Waziyatah which is decided in favor of Camp Waziyatah, I will be responsible for all legal fees, court costs, and out of pocket expenses of Camp Waziyatah, its owners and employees.

 

Final acceptance is subject to submission of all forms on a timely basis and approval by our medical staff and Director(s).


By checking this box, I have read, understand, and accept all of the terms and conditions set forth in 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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