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: gina@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 - 3:00pm (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 about us.*:

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