AT Retreat at Woods Hole Hostel

Camper Information

Camper's Name *

First Name Last Name

Birth Date *

Month Day Year

Camper's gender *

Additional campers' names and their birthdates, if applicable (Parent/Guardians must be the same).

Please note any special needs here (Note: you MUST contact The Mayapple School staff to ensure we can meet these needs before enrolling your child.)

Participant guardians understand and agree that their children may be photographed and/or videotaped for outreach purposes. *

Yes No

2021 Summer Camps at the Mayapple School are supported through the Appalachian Trail Conservancy’s Community Impact Grant Program. In order to provide summer camp programming to campers from families of all income levels, a minimum number of scholarship spots have been set aside for each camp. Full and partial scholarships are available.

Please find out your family’s income as a percent of the Federal Poverty Level (FPL) here.

Sign up for a "SCHOLARSHIP" spot if your family’s income is…

0 – 185% of the FPL, and pay $0 (full scholarship).
186 – 205% of the FPL, and pay $165 (greatly reduced fee scholarship)
206 – 225% of the FPL, and pay $305 (partially reduced fee scholarship)

Limit one scholarship per each child. Enrollment for additional sessions must occur at the "FULL TUITION" level.

Scholarships will be formally awarded and notification sent via e-mail when proof of income is received (upload below).

Sign up for a "FULL TUITION" spot if your family's income is...

More than 225% of the FPL, and pay $465 (no scholarship; full cost)

If you believe that you have other extenuating circumstances that affect your family's ability to afford summer camp for your children, please e-mail melissa@mayapple.org for a full scholarship application. You will receive a personal decision from The Mayapple School Board in 4-7 weeks regarding your scholarship award. If you have any other questions please also email melissa@mayapple.org

Sign up for a "WAITLIST" spot if the appropriate category is sold out.

The waitlist will be called on a first-come, first-served basis, and scholarships will be available to those that qualify.

Please select the session(s) you are enrolling your camper for. *

The Mayapple School will accept a variety of proof in order to award scholarships. You may upload files below, or mail a hard copy to The Mayapple School at 404 Mt. Tabor Rd. Blacksburg VA 24060. Proof can include: copies of annual tax returns, monthly pay stubs, statements from employers, acceptance letters for other government programs, or other 3rd party verified information. Prompt proof of income or need is required in order to award scholarships. All social security numbers or sensitive information should be redacted. Do not upload files if paying full cost.

Pay by credit card below. (If you would like to pay by check, please mail to "The Mayapple School 404 Mt. Tabor Rd. Blacksburg VA 24060." A lack of prompt payment will forfeit your spot. Questions? E-mail melissa@mayapple.org)

summer camp fee for one week $ 465.00

full cost

Quantity

full scholarship summer camp fee for one week Free

for families with incomes up to 185% of the federal poverty threshold

Quantity

greatly reduced (65%) scholarship summer camp fee for one week $ 165.00

for families with incomes up to 205% of the federal poverty threshold

Quantity

partially reduced (35%) scholarship summer camp fee for one week $ 305.00

for families with incomes up to 225% of the federal poverty threshold

Quantity

Total $ 0.00

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Date	Postal Code

Parent/Guardian Information

Name *

First Name Last Name

Phone Number *

Area Code Phone Number

E-mail *

Name

First Name Last Name

Phone Number

Area Code Phone Number

Email

example@example.com

Emergency Contact's Name

First Name Last Name

Relationship

Phone Number

Area Code Phone Number

Other persons authorized to pick up child:

Camper Forms and Additional Information

All camper families will be required to fill out forms including: health forms, field trip permission slips, and child registration forms, which are due upon arrival at camp. These will be e-mailed to you soon after you send in this form.
In order for camp to be successful, we will also be sending out a questionnaire about campers' dietary needs, backpacking equipment already owned and needed to borrow, and related information. This form should be filled out with your camper.
A packing list will be sent via email with the questionnaire. Bringing cell phones or other expensive electronics to camp will be discouraged. Woods Hole has limited if any cell service. Camper families will be able to call the Woods Hole landline if they need to get in contact with their camper.
A virtual question and answer session about the camp will be held on Thursday, June 3 for all campers and their families.

Medical Release and Authorization

Parental Waiver: As parent/guardian of participant(s), permission is granted to engage in the Mayapple School Summer Camp program. I understand there are risks of physical injury and illness to the participant(s). Considering all possible risks, on behalf of the participant(s) and myself, I voluntarily waive, release, discharge, and hold harmless the organization The Mayapple School, and their employees, supervisors, appointed officials, agents, representatives and volunteers from all claims for all injuries and illnesses to participant(s), as far as is allowable by law. Furthermore, I give consent for emergency medical treatment to the participant(s), no matter how severe.

COVID-19

Due to the global pandemic, risk mitigation procedures such as physically distanced and masked drop off and pick up, the wearing of masks by all campers and educators when within 6 feet of another including while outdoors, and related procedures are currently in effect at The Mayapple School. A full description of COVID-19 policies and procedures for summer camps will be sent to all camper families closer to the time of camp, to allow for the most up-to-date information and requirements.

In your questionnaire, you will have the opportunity to indicate your preferred tenting arrangements for your camper. All campers will have the opportunity to sleep in their own tent. We realize that some campers may come to the camp with siblings or with a member of a homeschooling pod or other member that they do not physically distance from, and that they may prefer to share a tent. We also recongize that some campers may feel uncomfortable tenting alone and families may be comfortable creating that relationship with another camper while at camp.

Do you have any questions that you would like us to follow up with you about before the question and answer session on Thursday, June 3?

Confirmation

By acknowledging and signing below, I affirm that I have read this form in its entirity; I agree to the terms of the above parental waiver; I agree to fill out all forms and adhere to packing lists; I affirm that the information on this form is true to the best of my ability.

Please sign here *

Clear