Discovery Weekend

1
Are you a parent/legal guardian?
Yes
No
2
What is your first name?* This field is required.
3
What is your last name?* This field is required.
4
What is your phone number?* This field is required.
Please enter a valid phone number.
5
What is your email address?* This field is required.
example@example.com
6
What's your home address?
Street Address
Street Address Line 2
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eSwatini
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Tokelau
Tonga
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Vietnam
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Isle of Man
US Virgin Islands
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Western Sahara
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Zambia
Zimbabwe
Other
Country
7
What is your camper's first name?* This field is required.
8
What is your camper's last name?* This field is required.
9
What is your camper's gender?* This field is required.
Girl
Boy
Non-binary/gender-fluid
10
What is your camper's current age?* This field is required.
11
What grade will your camper be attending in the fall?* This field is required.
12
Our cabins are girl or boy cabins. Which cabin type would your camper prefer to be in?* This field is required.
Girl cabin
Boy cabin
13
We do our best to intentionally match campers with similar personalities. Which of these best describes your camper? Select up to two.
Artsy & Introverted
Big-Hearted Performer
Sensitive & Smart (but Tired of School)
Quirky & Curious Explorer
Creative Free-Spirit with a Wild Imagination
Cautious & Self-aware
14
Could you please describe your camper a bit more for us? Please include anything on how camper experiences new social environments and any special needs they may have.
15
How will your camper arrive/leave camp?* This field is required.
We will be dropping off on Aug 7 and picking up on Aug 9
Our camper will be using the camp shuttle to/from Boston
I'm not sure yet
16
Does your camper have any known allergies or dietary restrictions? If so, please describe.* This field is required.
17
Will your camper be taking any medications or supplements while at camp?* This field is required.
Yes
No
18
What is the name of medication(s), the date started, the reason for taking it, when it is given (morning, midday, evening), amount given, and how it is given.
“Medication” is any substance a person takes to maintain and/or improve their health. This includes vitamins & natural remedies. Please review camp instructions about required packaging/containers. Many states require original pharmacy containers with labels which show the camper’s name and how the medication should be given. Provide enough of each medication to last for 2 nights and 2 days.
19
Is there anything else we should know about your camper?
20
My camper has my permission to participate in all camp activities except as noted by me above. I give permission to the physician or nurses on duty at camp to order x-rays, routine tests, and treatment related to the health of my child for both routine health care and in emergency situations. If I cannot be reached in an emergency, I give my permission to the physician to hospitalize, secure proper treatment for, and order injection, anesthesia, or surgery for this child. I understand the information on this form will be shared on a “need to know” basis with camp staff. I give permission to photocopy this form. In addition, the camp has permission to obtain a copy of my child’s health record from providers who treat my child and these providers may talk with the program’s staff about my child’s health status.* This field is required.
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21
Photo/Video Release: I grant Camp Medolark permission to photograph and/or video my child during Discovery Weekend. I understand that these images may be used for camp-related promotional materials, including social media, the Camp Medolark website, brochures, and other publications.* This field is required.
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22
Payment for Discovery Weekend* This field is required.
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Afghanistan
Albania
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American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
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Aruba
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Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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