2025 Summer Camp Registration Form

2025 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 February 26th. $425 Per Child Per Session
REMINDER: Your registration submission is a request. Your childs spot has not been secure until you receive a confirmation email from Camp Director Nina Wilson.

*A $100 deposit will be required for all non-members (member friends & family). Deposits can be droped that off at the club or mailed in. Please drop off or mail to the attention of Jesse Cauchon and make note it is the Kids Camp deposit.
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 MemberOther (not being billed to member account)
If a grandchild of a member please list the grandparent/members name or any other notes.
The following dates are the 2025 camp sessions. Please select the session(s) you would like to sign-up for.

June 23-26July 7-10July 14-17July 21-24July 28-31August 4-7August 11-14August 18-21
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)*

YesNoNot Sure At This Time
Will the camper(s) be staying for the "extended day" (4pm pick-up)? ($35 per child, per day)

YesNoNot Sure At This Time
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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2025 Kids Camp Registration

Camper Information