2023 Summer Camp Registration Form

2023 Kids Camp Registration
Join us this summer for one or more 4 or 5 day programs filled with a variety of activities! Boys and girls ages 5-10 are welcome. 8:45am Arrival; 3pm Pickup. Registration opens March 1st. $375 Per Child Per Session
Due to the high demand in camp interest last year, members will be able to register for a max of 2 sessions upon their initial registration. If interested in more than 2 session you will be placed on a waitlist for the other weeks of interest. If spots are available by April 15th you will be contacted and informed of the additional camps your child has made it into.

REMINDER: Your registration submission is a request. Your childs spot has not been secure until you receive a confirmation email from Camp Director Ella Fitzcharles.
Camper Information
Is the camper(s) a child or grandchild of an active member of Vermont National Country Club? *MANDATORY**

Child of Active MemberGrandchild of Active Member
The following dates are the 2023 camp sessions. Please select the session(s) you would like to sign-up for. Max of 2 sessions.

June 26-29July 3-6 (camp week 3rd, 5th, 6th, 7th, no additional day)August 7 - 10August 14 - 17
Please select any additional weeks you would like to be added to the waitlist for.

June 26-29July 3-6 (camp week 3rd, 5th, 6th, 7th, no additional day)July 10-13July 17-20July 24-27July 31-August 3August 7-10August 14-17
Camper 1 Name

First NameLast Name
Birth Date

MonthDayYear
Gender

MaleFemale
Camper 2 Name (if applicable).

First NameLast Name
Birth Date

MonthDayYear
Gender

MaleFemale
Will camper(s) be adding the additional day (Friday)? ($100 per child)

YesNo
Will the camper(s) be staying for the "extended day" (4pm pick-up)? ($50 per child, per day)

YesNo
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name

First NameLast Name
Home Number
Cell Number
E-mail
example@example.com
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Alt. Phone Number
Does the camper(s) have any allergies, chronic illness, or medical conditions? If yes, please describe.
Is the camper(s) prescribed an inhaler or epipen? If yes, please explain any instructions.
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Vermont National Country Club during the selected camp. I assume all risk and hazards incidental to the conduct of the activities. I release, absolve and hold harmless Vermont National and its representatives from any and all liability for injuries to said child arising out of traveling to, participating in or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against Vermont National Country Club.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
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2023 Kids Camp Registration

Camper Information