REGISTRATION FORM

Part 1: Camper Information

Camper's Name

First NameLast Name

Preferred Name / Nickname (if applicable)

Gender

Other

Preferred Pronouns

Date of Birth

Date

Entering Grade Fall of 2025

School Currently Attending

Camper's Email

example@example.com

Camper's Phone Number (if applicable)

Please enter a valid phone number.Format: (000) 000-0000.

Name of Parent/Guardian #1

First NameLast Name

Home Address of Parent/Guardian #1

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email of Parent/Guardian #1

example@example.com

Cell Phone Number of Parent/Guardian #1

Please enter a valid phone number.Format: (000) 000-0000.

Name of Parent/Guardian #2

First NameLast Name

Email of Parent/Guardian #2

example@example.com

Cell Phone Number of Parent/Guardian #2

Please enter a valid phone number.Format: (000) 000-0000.

Med-o-lark's Summer 2025 Tuition

Length	Dates	Session	Tuition
2 Weeks	June 26 - July 10	1A	$4,995
2 Weeks	July 10 - July 23	1B	$4,995
2 Weeks	July 24 - Aug 7	2	$4,995
2 Weeks	Aug 7 - Aug 20	3	$4,095
4 Weeks	June 26 - July 23	1	$8,000
4 Weeks	July 10 - Aug 7	1B & 2	$8,000
4 Weeks	July 24 - Aug 20	2 & 3	$7,295
6 Weeks	June 26 - Aug 7	1 & 2	$11,495
6 Weeks	July 10 - Aug 20	1B, 2 & 3	$10,995
8 Weeks	June 26 - Aug 20	Full Summer	$13,495

Secure your spot! Which dates would you like to enroll for?

T-Shirt Size

Does your camper have any cabinmate requests? (New families: Med-o-lark is a warm and welcoming environment. About half of our camp will be new this summer.)

Please share any details on cabinmate requests

Does your camper have any siblings attending camp?

Name(s) of sibling(s) attending camp (if applicable)

Siblings get 10% off

Age(s) of sibling(s) attending camp (if applicable)

Previous camps attended (if applicable)

Do you have any concerns regarding your child's behavioral or social life? Have you encountered any difficulty at home, school, or at a past camp?

How did you hear about Camp Med-o-lark? E.g. Social Media, Internet Search, Referral Agency, Camp Fair, Family/Friend. If on the web, please include the website so we can thank them.

Would you be interested in enrolling in any of these exciting out-of-camp adventures?

Would you be interested in horseback riding? This is an elective afternoon activity and we will transport campers to Lupine Farms in Vassalboro, Maine (30 mins away). Lupine Farms is the home of the Colby College equestrian team.

By registering your camper, you agree to Camp Med-o-lark's Terms & Conditions.

Please acknowledge you have read our Terms & Conditions

How would you like to pay for your camper's $750 deposit? Please select one.

Please make your check payable to Camp Med-o-lark. Our mailing address is:

82 Medolark Rd

Washington, ME 04574

Please email us at welcome@medolark.com to let us know you are paying by check.

My Products

Secure Your Spot - Deposit

Secure your camper's spot with a $750 deposit.

$750.00

Any Amount

$1.00 Quantity

Subtotal

Tax

Total

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country