Online Enrollment Application Camper DetailsCamper's Name* First Last Nickname CellPhone*Birthdate* MM DD YYYY Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Height*Weight*Parent's Email* Camper's Email Camper Age on August 1 (Years & Months)Grade Camper Will Enter Next FallSessionsNumber of Weeks Applying For*2 Weeks at camp4 Weeks at camp6 Weeks at camp8 Weeks at campWhich 2 Weeks are you Applying For?*2nd 2 Wks. Sun July 8 - July 213rd 2 Wks. Sun July 22 - Aug 44th 2 Wks. Sun Aug 5 - Aug 18Which 4 Weeks are you Applying For?*2nd 4 Wks. Sun July 8 - July August 43rd 4 Wks. Sun July 22 - Aug 18Which 6 Weeks are you Applying For?*2nd 6 Wks. Sun July 8 - Aug 18Parent DetailsParent Name* OccupationBusiness AddressPhone*Parent Name OccupationBusiness AddressPhoneSummer Address*Phone*At Summer Address From At Summer Address Until ReferencePlease Provide the Name of a Teacher Who Is Able to Give a Camper Recommendation: (We will forward the necessary forms. Returning campers omit.)Teacher's Name* School Phone*School Address*Zip*Teacher's Home AddressHome PhoneGrade*Additional DetailsTo Assess the Effectiveness of Promotion, Please Share How You Heard About Roaring Brook:So that we may do our best in working with your son at camp, we ask that you reply to the following questions. The Roaring Brook program has assisted many boys in their personal growth, but it is not designed as a therapeutic course. It is simply an experience for boys who are excited about learning outdoor skills and enjoying a true outdoor adventure. If necessary you may attach additional sheets. Thank you very much for your assistance.What do you wish your son to gain from his experience at Roaring Brook?Are there areas in which your son has particular difficulty?These might be physical limitations, learning or attention deficit disorders or simply low self-esteem in relation to peers. If so, is he receiving help in these areas? Please note: Parents must inform the camp, in advance, of any medications their son is taking to assist with these difficulties or medications taken for medical problems to determine if the camp can accommodate their medication schedule. Campers must be physically capable of participating in an active program.How does your son interact with other children individually or in a group?Please note: Roaring Brook cannot accommodate boys with any history of social or behavioral disorders that have caused problems at home or school.When a boy comes to camp from a home that is undergoing change (new location, separation, divorce etc.) his experience is often affected. Are any of these changes a part of your son's life, and if so, how is he adapting?This information will be shared with the counselors who will be living with your son. It will allow them to better meet your goals for your son's growth and his physical needs, social interaction skills and personal learning style at camp. We consider ourselves part of a team dedicated to your son's development in self-reliance, resourcefulness and the will-to- achieve in life, as well as learning and enjoying exciting outdoor skills.Agreement MEMBERSHIP. We welcome all boys 9-16 that are sincerely interested in our program of outdoor experiences who will adhere to camp policies. DEPOSIT. A registration deposit of one half of the tuition payable to Roaring Brook Camp should accompany the application. We accept Mastercard or Visa. List the name, number, and expiration date in the space provided on the application form. HEALTH REPORT AND INSURANCE COVERAGE. Tuition includes all expenses, trips, and some craft materials, but not accident and health insurance. Parents should keep their son(s) on their family medical plan. Upon receipt of the application, a health form is to be filled out by the family doctor. Physical examinations are required of all campers. The health form also asks for the name of your insurance carrier and policy number. The health form must be completed and returned before the participant is permitted to attend Roaring Brook Camp. Charges for medical services including physician fees, prescriptions, hospital fees, special medical supplies and ambulance service, but excluding first aid service at camp shall be charged to the parent/guardian and paid by the parent/guardian. In the event of an illness or emergency requiring the services of a physician, every effort will be made to notify parents to discuss the nature of the problem and the course of treatment pursued. Applications are not considered complete until the medical form is received and approved. TEACHER RECOMMENDATION. The application form requests the name of a teacher who will provide a recommendation. Roaring Brook sends the form to the teacher. Unless notified, participants from previous summers may omit this information. Applications are not considered complete until the teacher recommendation is received and approved. TUITION DISCOUNTS. A 10% discount is given for two or more campers from the same family and to those who wish to bring a friend to camp for 4 or 6 week campers. The discount is applied to your registration fee. The Bring-A-Friend discount is only for friends who are first year campers attending the four/six-week session. Brother and Bring-A-Friend discounts may not be combined with other promotional discount programs. Provide the names of friends in the space at the bottom of the application form. Early enrollment discounts are also provided for sessions.. Early enrollment discounts may not be combined with other promotional discount programs. FINAL PAYMENT. The balance of the tuition is due May 1 for campers enrolled before May 1. Any camper applications made after May 1 must be accompanied by full payment. Roaring Brook Camp may reject any applicant for which payments have not been received on time and in such case shall have no obligation to refund payments previously made. A 2.0% penalty interest per month on all accounts not completed by May 1 or if total payment is not received with applications made after May 1 will be enforced. REFUND POLICY. Applications withdrawn before May 1, will be refunded. A $200.00 processing fee for 2 weeks; $400.00 for 4 weeks; $600.00 fee for 6 weeks will be charged against withdrawn accounts to recover the cost of this service. Withdrawal notification must be made in writing and be postmarked prior to May 1. Applications withdrawn after May 1 will not be refunded. If a camper must withdraw while attending camp because of a medically proven illness or accident, then a prorated refund will be made. If a camper voluntarily leaves or is asked to leave because of his behavior, there will be no refund. NOTE: Since most of our operating costs are based on pre-paid fees, which stem from the group size rather than a per-person per day basis, pro-rated refunds for medical withdrawal while attending camp are minimal. It is suggested that parents obtain tuition refund insurance to protect their investment. ADDITIONAL EXPENSES. Eighty ($80) is to be left on deposit with the camp directors for such items as stamps, toothpaste, film, etc. or a doctor’s visit. If a camper arrives without critical gear, the parents/ guardians will be contacted to request permission for purchase locally. If a participant should make a knife, ax, or moccasins while at camp; knife blades, axeheads, and leather are charged at cost (approx. $50.00 per item). All other craft supplies are included in the tuition. In addition, a $15.00 laundry charge and a $12.00 photograph charge are made. No additional spending money is necessary. There is no camp store. Campers should not keep money or valuables in their possession while at camp. RULES AND POLICIES. For the health, safety and welfare of themselves and their companions, campers are expected to obey the rules and policies of Roaring Brook Camp. Smoking, alcohol, and drug abuse are prohibited. Dishonesty, theft, or the borrowing of other people's belongings without permission is a serious offense. The continued use of obscene , discriminatory or sexual language is considered grounds for dismissal. Campers are not permitted to use the waterfront, tyrolean traverse, rope's course, rock climbing area, riflery or archery equipment, tools, axes, knives, or the forge at the blacksmith shop without the direct supervision of a staff member. Other activities requiring supervision will be specified during the camp session. Initiations or the hazing of campers is not permitted. Campers are expected to obey their counselors and trip leaders in accordance with camp rules and policies. Campers are expected to exhibit behavior which does not physically or mentally threaten the welfare of others. Campers are expected to exhibit behavior which is an acceptable model for group living situations. The failure of a camper to adhere to the camp rules, policies and behavior expectations may result in immediate expulsion without refund. EQUIPMENT LOSS OR DAMAGE. Roaring Brook Camp insurance does not cover the personal property and equipment of participants or staff. Parents should check their insurance policies to be sure their son's gear is covered against loss, theft or damage. Parents/guardians will be held responsible for the willful destruction or loss by the participant of any equipment belonging to Roaring Brook Camp and thereby agree to reimburse Roaring Brook Camp for such loss or destruction of equipment. CHANGES IN ITINERARY. Roaring Brook Camp intends to follow the program schedule and itinerary as presented in its brochure and other publications, however weather conditions, water level, or safety considerations may require a change of itinerary. If an activity or trip is deleted, it will be replaced by another activity or trip. CANCELLATION OF THE PROGRAM BY THE CAMP. If for any reason prior to the start of a camp session the session must be canceled, Roaring Brook Camp shall refund all monies paid by parents/guardians. If during a camp session it is necessary to terminate a camp session, a proportion of the unused monies will be refunded. MODEL RELEASE. The parents/guardians of the participant give permission that any camp films or photographs showing their child may be used for camp publicity purposes in a reasonable and proper fashion. LIABILITY RELEASE. Submission of the registration application indicates that the parents/guardians believe their son(s)/ward(s) to be capable of handling both the emotional and physical aspects of the Roaring Brook Camp program and he is enthusiastic about participation. With the signing of the application the parents/guardians serve notice that they have read and agree to all the Registration Terms of Agreement and agree to release Roaring Brook Camp, its agents and the services it contracts with, of any and all liability of responsibility of any nature whatsoever, for any loss/damage to property or personal injury incurred while their son(s)/ward(s) are attending the program under the direction of Roaring Brook Camp. COMPLETION OF REGISTRATION/NOTIFICATION OF ACCEPTANCE. Receipt of the application form, registration fee, teacher recommendation, and health form completes the application process. Completed applications are subject to camp director approval prior to enrollment. Parents will be informed of the applicant's status within 14 days of the receipt of all materials only if there is a problem. Unless otherwise notified, returning campers and alumni are enrolled upon receipt of the application form and necessary fees. CHANGE OF TERMS. Roaring Brook Camp retains the right to change or retract the terms of agreement, rules, policies and other conditions stated within the camp catalog or other camp literature printed by Roaring Brook Camp and to make any other reasonable terms, rules, policies, and conditions that Roaring Brook Camp determines to be necessary for the well-being and safety of the participant, his parent/guardian and Roaring Brook Camp. I Have Read and Agree to All the "Registration Terms of Agreement" as Stated in the Literature.* This Application Has My Approval Date* Type in the letters belowTotal $0.00 Camp Session This iframe contains the logic required to handle Ajax powered Gravity Forms.