WINTER CAMP 2026/27 REGISTRATION FORM

Name *

Birthday *

Gender *GenderMaleFemale

Parent 1 Name *

Parent 1 Phone *

Parent 1 Email

Parent 2 Name

Parent 2 Phone

Parent 2 Email

Credit Card Information - Secure *

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Half Day 9:00 - 12:45

• 3 Days of Camp: $425
• 5 Days of Camp: $650

Full Day 9:00 - 2:45

• 3 Days of Camp: $550
• 5 Days of Camp: $800

Please check the days your child will be attending *

• Monday, December 28th
• Tuesday, December 29th
• Wednesday, December 30th
• Thursday, December 31st
• Friday, January 1st (HALF DAY ONLY- 12:45 PICK UP FOR ALL CAMPERS)

Check boxes below to indicate if your child has any allergies, special needs/services, or medical conditions:

• Allergies
• Asthma
• Medical Conditions
• Special Education
• Occupational/ Physical Therapy
• Speech/Language Delay

Agreements

• I consent to emergency medical treatment for my child

Agreements *

• I understand my child may not attend camp if he/she has one or more of the following symptoms. Fever over 100.4, vomiting, diarrhea, undiagnosed rash, has started antibiotics in the past 24 hours, congestion/coughing. We kindly ask that you keep sick children home for minimum of 24 hours.

Agreements *

• I understand that I am responsible for ensuring my child is covered by health insurance and that any injury or illness incurred at camp is the financial responsibility of the parent and not that of The Country School

Agreements *

• Arrival/Dismissal- Please do not arrive at camp earlier then your scheduled drop off time and implement curbside drop off and pick up procedures. Please be prompt when picking up your camper.

Agreements

• I give permission for my contact information to be shared with other camp parents.

Emergency Contacts/Approved Pick-Up Contacts Other Than The Parent *

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Emergency Contacts/Approved Pick-Up Contacts Other Than The Parent

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Emergency Contacts/Approved Pick-Up Contacts Other Than The Parent

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