Camp Podooc Application Form Lake George Regional Park
No screens. just fresh air, fresh water, and fun!
Camp Podooc is a day-camp conducted on the WEST side of Lake George Regional park that runs in 2 distinct 2-week sessions for area youth, grades 1-6. 9:00-2:30. Campers experience swim lessons, outdoor field games, nature crafts, drama programming, environmental education, and have free lunch available.

Skowhegan (and area): Bussing from Skowhegan Rec Center (pick up 8:45, drop off 2:45)
SESSION #1 July 8-19

Canaan (and area): No bussing, parents provide transportation directly to Lake George
SESSION #2 July 22-Aug 2
FREE to Canaan residents. Vacant slots available to non-residents for fee.


Please complete this request form and we will be in touch with you!
DEADLINE: Friday JUNE 22nd
Choose a session
Camper Name (first, last) *
Your answer
Age *
Grade (entering in Fall) *
Camper Health History (please check all that apply)
Check if applicable (past or present)
Frequent ear infections
heart disease/defect
diabetes
convulsions
bleeding/clotting disorders
Seizure disorder
chicken pox
measles
german measles
mumps
Severe allergies:
Allergy: insects stings (Epi pen)
Allergy: peniciliin
Asthma
Health concerns (other)
Your answer
Current medications (list all prescriptions):
Your answer
Medications to be administered at camp:
Your answer
Parent First Name *
Your answer
Parent Last Name *
Your answer
Company
Your answer
Street Address *
Your answer
Town *
Your answer
State *
Your answer
Zipcode *
Your answer
Email *
Your answer
Contact Telephone Number *
Your answer
Name of emergency contact #1: *
Your answer
Phone number of emergency contact #1: *
Your answer
Name of emergency contact #2: *
Your answer
Phone number of emergency contact #2: *
Your answer
Transportation Information (Session one only) *
Photo Release *
Authorization for treatment
I hereby give permission to the camp personnel selected by the camp director to administer medication as directed and/or to arrange for emergency medical treatment as needed.
Consent for Participation
By completing this form, I give consent for my child to participate in Camp Podooc. This application and health history is correct so far as I know, and the camper has permission to participate in all prescribed camp activities except as noted. Further, I consent to the camper's participation in the athletic ventures, games, and sports events sponsored by the Lake George Corporation, and by this assent and consent do hereby assume all responsibility for any injuries and damages related thereto that said camper may receive or sustain as a result of the incident to the participation therein or any activity thereof. Also, I hereby agree to indemnify, protect, and save harmless the Lake George Corporation and its Officers, Directors, Agents, Servants, and Employees from all judgements, costs, and expenses whatsoever arising on account of any action, claim, or demand by said camper or by any person acting on behalf of said camper in respect of any claimed injuries or damages.
I give authorization for treatment, and consent for participation. *
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