2019 The Green School Summer Camp Registration Form
Email address *
Camper #1 Full Name: *
Your answer
Camper #1 Date of Birth: *
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Camper #1 Gender:
Camper #2 Full Name:
Your answer
Camper #2 Date of Birth:
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Camper #2 Gender:
Camper #3 Full Name:
Your answer
Camper #3 Date of Birth:
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Camper #3 Gender:
Parent/Guardian #1 Full Name: *
Your answer
Parent/Guardian #1 Permanent Address: *
Your answer
Parent/Guardian #1 Summer Address: *
Your answer
Parent/Guardian #1 Cell Phone Number: *
Your answer
Parent/Guardian #1 Home Phone Number: *
Your answer
Parent/Guardian #1 Email Address: *
Your answer
Are you interested in year round weekend programming? *
How did you hear about The Green School? *
Parent/Guardian #2 Full Name:
Your answer
Parent/Guardian #2 Permanent Address:
Your answer
Parent/Guardian #2 Summer Address:
Your answer
Parent/Guardian #2 Cell Phone Number:
Your answer
Parent/Guardian #2 Home Phone Number:
Your answer
Parent/Guardian #2 Email Address:
Your answer
Emergency Contact #1 Name: *
Your answer
Emergency Contact #1 Cell Phone Number: *
Your answer
Emergency Contact #2 Name:
Your answer
Emergency Contact #2 Cell Phone Number:
Your answer
Family Dr. Name:
Your answer
Family Dr. Phone Number:
Your answer
Insurance Coverage & Policy Number:
Your answer
Does Camper #1 have any known allergies? If so, please list. *
Your answer
Does Camper #2 have any known allergies? If so, please list.
Your answer
Does Camper #3 have any known allergies? If so, please list.
Your answer
List the name(s) of anyone, other than yourself, that has authorization to pick up your child: *
Your answer
Child Release Password: (your child will not be released to anyone, other than those listed above, without knowing this password) If you do not wish to list one, write "n/a". *
Your answer
Special Instructions/Notes about your child(ren):
Your answer
Select the dates your child(ren) will attend The Green School camp: *Add-ons listed below*
5 days (m-f)
3 days (m/w/f)
2 days (t/th)
Spring Wk 1: June 10th - 14th
Spring Wk 2: June 17th - 21st
Summer Wk 1: June 24th - 28th
Summer Wk 2: July 1st - 5th
Summer Wk 3: July 8th - 12th
Summer Wk 4: July 15th - 19th
Summer Wk 5: July 22nd - 26th
Summer Wk 6: July 29th - August 2nd
Summer Wk 7: August 5th - 9th
Summer Wk 8: August 12th - 16th
Summer Wk 9: August 19th - 23rd
Summer Wk 10: August 26th - 30th
Select the Green School Add-Ons: (Extended day until 2pm and/or Riding Lessons)
Ext Day (m-f)
Ext Day (m/w/f)
Ext Day (t/th)
RL: mon (1-1:30)
RL: tues (1-1:30)
RL: wed (1-1:30)
RL: wed (2-2:30)
RL: thur (1-1:30)
RL: fri (1-1:30)
Spring Wk 1: June 10th - 14th
Spring Wk 2: June 17th - 21st
Summer Wk 1: June 24th - 28th
Summer Wk 2: July 1st - 5th
Summer Wk 3: July 8th - 12th
Summer Wk 4: July 15th - 19th
Summer Wk 5: July 22nd - 26th
Summer Wk 6: July 29th - August 2nd
Summer Wk 7: August 5th - 9th
Summer Wk 8: August 12th - 16th
Summer Wk 9: August 19th - 23rd
Summer Wk 10: August 26th - 30th
Select the dates your child(ren) will attend Jr. Pony Camp:
Jr. Pony Camp 5 days (m-f)
Jr. Pony Camp 3 days (m/w/f)
Jr. Pony Camp 2 days (t/th)
Spring Wk 1: June 10th - 14th
Spring Wk 2: June 17th - 21st
Summer Wk 1: June 24th - 28th
Summer Wk 2: July 1st - 5th (no camp July 4th)
Summer Wk 3: July 8th - 12th
Summer Wk 4: July 15th - 19th
Summer Wk 5: July 22nd - 26th
Summer Wk 6: July 29th - Aug 2nd
Summer Wk 7: Aug 5th - 9th
Summer Wk 8: Aug 12th - 16th
Summer Wk 9: Aug 19th - 23rd
Summer Wk 10: Aug 26th - 30th
TERMS AND CONDITIONS:
(1) Medical form and horseback riding waiver is due by June 1st regardless of your child’s start date.
(2) No refunds will be granted for sick or absent days. There are no make-ups for missed days.
(3) I agree to the tuition charges for the programs that I signed up for.
(4) No child will be released to a non-family member without knowing the CHILD RELEASE PASSWORD indicated in this registration form.
(5) The legal guardian(s) hereby gives approval & consent for child's participation in the activities of The Green School.
(6) The legal guardian understands & acknowledges that his/her child’s participation in the activities of The Green School are completely voluntary and has familiarized him/her with the activities in which hazards and/or dangers are inherent. On a regular basis children interact with chickens, pigs, goats, sheep, horses (including pony rides), rabbits, and a donkey. Accordingly, The Green School has taken safety measures to minimize the risk of injury to the participants in such activities.
(7) The Green School cannot ensure or guarantee that the equipment, premises and/or activities will be free of hazards, accidents or injuries.
(8) The child and legal guardian agree to abide by all rules and regulations established by The Green School for the health, safety and welfare of everyone involved.
(9) If in the judgment of the Program Director it is deemed necessary to use medical, surgical or dental aid for the child’s health, the legal guardian hereby permits the Program Director to do so.
(10) All photos taken during the course of the program are the sole property of The Green School and can be used as deemed necessary, including but not limited to any/all promotional purposes.
DEPOSIT AND REFUND POLICY:
A 50% deposit is due at the time of registration to reserve your child(ren)'s space. The balance is due in full and must be received no later than May 1, 2019. A $25 service fee per child will be charged for changes made after we received your registration. Cancellations received before May 1, 2019 will be refunded less a $150 service fee per child. There are no refunds for cancellations received after May 1, 2019. Payment is due in full at the time of enrollment for all registrations received after May 1, 2019.
In the event of serious illness or accident during or before camp, a prorated refund will be given when accompanied by a physician's letter minus the $150 service fee per child. There is a $25 service fee for each returned check.
In the event that your balance has not been received by the deadline of May 1, 2019 your child's registration will be reduced to the amount of time equal to the deposit received. This will be calculated from the first week of their registration. Refer to the tuition rates posted on The Green School website.
I have read and fully understand the above terms and conditions: *
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*By signing I acknowledge my electronic signature is legal and binding.
Signature: *
Your answer
Payment is acceptable in the form of check or credit card. Select payment type: *
*If paying by credit card an invoice with a secure link for payment will be sent within 2 business days after we receive your registration. Enrollment is not confirmed until we receive payment.
Name on credit card:
Your answer
Email to send invoice to:
Your answer
Our experienced staff works diligently to care for your child and create a wonderful camp experience. As a convenience to our clients, a staff gratuity is added to your total camp tuition in the amount of $50 per child per week (pro-rated for 3 days & 2 days/week, pony camp and riding lessons). This additional charge will be reflected on your final invoice.
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