Camp Summerset

Application

To guarantee a place, a NON-REFUNDABLE DEPOSIT OF $150 PER CHILD IS DUE ONCE THIS APPLICATION IS FILLED OUT.
Upon submitting the application, you can pay by credit card thru Paypal, or mail in your deposit.
Please use a new application for each child.

Please fill out our online Medical and School Authorization forms 
Medical & Transportation Authorization 
School Authorization

If you prefer,  print, scan and return to us by email:tara@campsummerset.org OR by mail:
Medical & Transportation Authorization
School Authorization 
OR  mail to:
The Learning Institute c/o Registrar
PO Box 186 Goldens Bridge, New York 10526

    Parent's First Name*:

    Parent's Last Name*:

    Address*:

    City*:

    State*:

    Zip*:

    Email Address*:

    Parent's Home Phone*:

    Parent's Cell Phone*:

    Child Information:

    Child's First Name*:

    Child's Last Name*:

    Child's Current Grade*:

    Teacher's Name:

    Child's Date of Birth*:

    Child's School*:

    School Address*:

    City*:

    Zip*:

    Interested in:

    Enrichment Program 1:00 - 2:30pm (additional $350)

    My child would like to be in the same group as (Choose one friend. Will try to accommodate:

    Has your child attended camp before?:

    Yes
    No

    May we have permission to contact your child's teacher?:

    Yes
    No

    May we have permission to publish your child's photo in future camp brochures or camp materials?:

    Yes
    No

    Please indicate how you heard about us.*:

     

     

    If you prefer to pay by check, please click SUBMIT and then mail your payment to The Learning Institute c/o Registrar
    PO Box 186 Goldens Bridge, New York 10526