Camper Registration Camper Personal Information Camper's Name(required) Gender(required) Male Female Non-Binary Date of Birth: MM/DD/YYYY(required) Entering Grade Fall of 2024(required) School currently attending(required) Camper's Email and Phone Number Parent/Caregiver information Name of Parent/Guardian #1(required) Home address of Parent/Guardian #1(required) City(required) State or Province (required) Zipcode or Postcode (required) Country (required) Email of Parent/Guardian #1(required) Cell Phone of Parent/Guardian #1(required) Home Phone of Parent/Guardian #1 Work Phone of Parent/Guardian #1 Profession of Parent/Guardian #1 Name of Parent/Guardian #2 Home address of Parent/Guardian #2 (if different than Parent/Guardian #1) City State or Province Zipcode or Postcode Country Email of Parent/Guardian #2 Home Phone of Parent/Guardian #2 Work Phone of Parent/Guardian #2 Cell Phone of Parent/Guardian #2 Profession of Parent/Guardian #2 Sessions Choose one(required) First Session (4 Weeks) – $7,800 – Friday June 28th to Wednesday July 24th Second Session (3 Weeks) – $6,000 – Friday July 26th to Wednesday August 14th (Limited Availability Remaining) 2A (2 Weeks) Session – $4,700 – Friday, June 28th – Thursday, July 11th (New for 2024) 2C (2 Weeks) Session – $4,700 – Friday July 26th to Thursday August 8th (Limited Availability Remaining) Six Week Session – $11,300 – Friday June 28th to Thursday August 8th Seven Week session – $11,800 – Friday June 28th to Wednesday August 14th Medical Information For the following required medical questions type NONE in the fields if no medication is being taken. Medications Taken(required) Dosage(required) Time(s) of day meds are taken(required) Other Medical Information Food Allergies or Requirements Other Information T-Shirt Size(required) Youth Small Youth Medium Youth Large Youth Extra Large Adult Small Adult Medium Adult Large Adult Extra Large Adult 2XL Cabinmate request Name(s) and Age(s) of sibling(s) – A 10% discount is given to each additional camper from the same immediate family Previous Camps Attended Any behavioral or social problems at home, school, or a past camp? How did you hear about Camp Med-o-lark? (Social Media, Internet Search, Referral Agency, Camp Fair, Family/Friend, Previously attended Med-o-lark, Etc.)(required) If you found Camp Med-o-lark via an internet search, please list the website or search term that directed you to us. Extras Select desired trip additions Whitewater Rafting, available First Session on July 11th and Second Session on August 1st ($125, non-refundable) Irving Berlin's White Christmas The Musical at Maine State Theater, available First Session on July 19th ($100, non-refundable) By submitting this online registration, I understand and agree to all Camp Med-o-lark policies, terms, and conditions of enrollment, including the following: A $750 deposit must accompany this registration form to guarantee a space for a camper. The balance of all fees is to be paid in full by May 1st. Any enrollment after May 1st requires payment in full. Camp tuition includes all meals, snacks, laundry, activities, and trips (excluding add-ons). Camp tuition does not include the cost of transportation to camp, add-on trips, or the canteen account. The camp reserves the right to dismiss disruptive or abusive campers or campers who show signs of physical or emotional difficulties that the camp does not feel capable of supervising. There will be no refunds issued for early departure related to disciplinary problems or homesickness. There may be a proportionate refund of payment for cancellation or early departure of campers with medical or family emergencies.Camp Med-o-lark operates with the highest possible safety standards. However, we do not assume liability for accidents, illness, or disease. In case of accidents or sickness. I hereby authorize any physician(s) selected by the camp to order x-rays, routine tests, and other medical treatment needed for the health of my camper. In the event I cannot be reached in an emergency, I give permission to the physician(s) elected by the camp director to hospitalize, secure proper treatment, and to order injections, anesthesia, and/or surgery for my child.Permission is granted to Camp Med-o-lark or its authorized entity or individual, with no additional charge, for the use of photographs and/or video of campers for social media, promotional purposes, or camp advertising in perpetuity.I give the camp permission to use our family’s contact information for a reference to be given to perspective campers and staff. This information may also be shared with the camper’s counselors and/or camp nurses and otherwise is considered confidential. It is agreed that any dispute or cause of action arising between the parties, whether out of this agreement or otherwise, can only be brought in a court of competent jurisdiction located in Knox County, Maine, and shall be construed in accordance with the laws of Maine.Payments may be made by check, Visa, American Express, or MasterCard. For payments by check, please promptly mail it to the camp office once you have completed the application. Camp Med-o-lark82 Medolark RoadWashington, ME 04574 Choose a payment method I will mail a check I will pay by credit card PRIVACY STATEMENTCamp Med-o-lark does not share any information with any other individuals or companies. Information you provide is not given or sold to any individuals or companies.CANCELLATION POLICYCancellations made prior to May 1st will be refunded less the $750 deposit. No refunds will be issued after May 1st.By clicking on the Submit Field, you are agreeing that you have read the policies above and agree with the conditions stated and have provided your signature. Submit
