Camp Cayuga by gdf57j

VIEWS: 5 PAGES: 2

									                                                                                                                                FOR OFFICE USE ONLY:



                                         Camp Cayuga                                                                            Recvd________________
                                                                                                                                DepAmt ______________
                                                                                                                                Check#_______________
                                                                                                                                Cabin ________________
                                                                                                                                                              CAMPER ENTRY#




                                     2011 Camper Enrollment Application
                                                                                                                                Source _______________
                                                                                                                                Confirm_______________
                                                                                                                                Notes:________________        SIBLING ENTRY#




     RETURN TO: CAMP CAYUGA SUMMER OFFICE, 321 NILES POND RD, HONESDALE PA 18431. PHONE: 570-253-3133, FAX: 570-253-3194.




Camper’s Name (print).…………………………………………….………………... Date Of Birth.……………..………………...                                                                    Male,     Female

Home Address (print).……………………………………………………………………………….………………………………………….………………

Home Phone.………………………….……………. Entering Grade…….. in September ‘11. School.……………………..………………………..

Camper’s Email.………………………………………………………………………….….. Include This Email In Pen-Pal Directory?                                                                    Yes,        No.

Parent #1 Name (who resides with camper).…………………………………………….……... Email.………………………………………………………

Parent #1 Cell Phone..………………………………….………………………. Business Phone.………….…………………………………………..

Parent #2 Name (who resides with camper).………………………………………………..…... Email.………………………………………………………

Parent #2 Cell Phone.………………………………………………………..…. Business Phone.……….……………………………………………..

Fax Machine #.…………………………………………………………………… For:                                                   Home,      Parent #1 Workplace,          Parent #2 Workplace

Name & Home Address Of              Mother or     Father - Only If Different Than Camper’s Address. (This parent does not reside with camper.)

……………………………………………………………………………………………………………………………………………………………………

Emergency Contact Person (other than parent).……………………………………………………... Relationship……………....………………………..

Emergency Contact’s: Home Phone #……………………………….... Work #…………………………... Cell #……………………………………
Returning Cayuga Camper?             Yes,     No. Attended Cayuga:        2010,   2009,    2008,   2007,    2006,   2005,    2004,    2003,         2002,    2001.

New Camper?           Yes,    No. How Did You First Learn About Cayuga?              Friend (last name).……………………….………….…….., or                                Sibling,

or     Internet (site name)………………….………., or                  Other……….….………..………………… Child’s Former Camp.……..….………………….


SUMMER SESSIONS: Check-off your session below:                                                 DISCOUNT
                                                                                                TUITION          SAVINGS
                                                                                                                                 2011 TUITION
                                                                                                                                (Before Discount)

     Full Season (54 days)…………Sunday, June 26 to Thursday, August 18, 2011……               ….....$7800……... ….. $0………...……….$7800
     First 6 Weeks (41 days)……… Sunday, June 26 to Friday, August 5, 2011.…………             ..…...$6600…..…. ….. $0………...……….$6600
     Last 6 Weeks (40 days)……… Sunday, July 10 to Thursday, August 18, 2011…….             ..…...$6600…..…. ….. $0…….…..……….$6600
     First-Half (27 days)…………… Sunday, June 26 to Friday, July 22, 2011.…………..                                          ……….$4400
                                                                                           ….....$4400…..…. ….. $0….….....
     Second-Half (27 days)……….. Saturday, July 23 to Thursday, August 18, 2011…..          ….....$3550……... ….. $850..…………….$4400
MINI 2-WEEKS:
     First 2-Weeks (13 days)………Sunday, June 26 to Friday, July 8, 2011……………                ……..$2400…..…. ….. $0…….….. ……….$2400
     Second 2-Weeks (13 days)…..Sunday, July 10 to Friday, July 22, 2011.…………..            ……..$2400..….....….. $0…...……
                                                                                                                       ……….$2400
     Third 2-Weeks (14 days)…….. Saturday, July 23 to Friday, August 5, 2011.…….…          ……..$1925……... ….. $475….…. ……….$2400
     Last 2-Weeks (12 days)………Sunday, August 7 to Thursday, August 18, 2011….              ……..$1725..……. ….. $675…….. ……….$2400

CREDIT FOR SIBLINGS: Cayuga extends a discount to families who enroll 2 or more children. The tuition is credited $400 for each
additional sibling enrolled for the full-season and $300, $200, and $100 for the 6-week session, half-session, and 2-week session respectively.

OPTIONAL TRIPS & SERVICES:                     If undecided, you can register later using the Camp Forms that are accessible on Cayuga’s website.
     Yes,   No.   Busch Gardens, Virginia Trip. Must be entering 6th grade or higher. Dates: July 13th, 14th, 15th, 2011. Fee $385. See website for details.
     Yes,   No.   Canada & Niagara Falls Trip. Must be entering 6th grade & higher. Dates: July 27th, 28th, 29th, 2011. Fee $385. See website for details.
     Yes,   No.   Camp’s Bus & Baggage Service. If yes, refer to reverse side for details.
     Yes,   No.   Camp’s Special Airport Transportation Service. If yes, refer to reverse side for details.
     Yes,   No.   Camp’s Linen Rental Service. If yes, refer to reverse side for details.

OPTIONAL PROGRAMS: If undecided, you can register later using the Camp Forms that are accessible on Cayuga’s website.
     Yes,   No.   Private One-On-One Tennis Lessons. Fee $35. See website for details. Number of lessons requested:_______.
     Yes,   No.   Paintball Sessions. Fee $35. See website for details. Number of sessions requested:_______.
     Yes,   No.   Suzuki ATV Quad Riding Sessions. Fee $35. See website for details. Number of sessions requested:_______.
     Yes,   No.   Academic Tutoring Lessons. Fee $35. See website for details. Number of lessons requested:_______.

  JUNIOR CAMPUS or TEEN CAMPUS: Campers who are 1) Entering 8th grade in September 2011 and 2) Age 13 before arriving at camp
are eligible to reside on either Junior Campus or Teen Campus. If your child meets these 2 conditions, indicate which Campus you prefer.
                     THIS APPLICATION MUST BE SIGNED BY A PARENT ON THE REVERSE SIDE. A $500 DEPOSIT IS REQUIRED.
CAMP TUITION - A deposit of $500 is required to process each enrollment                                OPTIONAL LINEN RENTAL SERVICE - This service includes sheets, pillowcases, and blankets.
application. Your final balance is due 10 days from the date indicated on your                         Pillows, towels, and washcloths are not included and need to be provided by the camper. The charge
first invoice for the current camp season. Accounts that are not paid in-full by                       for this optional service is $110 (full-season), $80 (6-week session), $55 (half-session), and $30 (2-week
this date will forfeit all tuition discounts (sibling credits & early registration credits) and        session). There is no prorated refund for this service if a camper arrives late or departs early from
may be cancelled at the discretion of the camp. The camp tuition includes: board,                      camp. Note: The weekly laundering of all linens (and clothing) is included in the Canteen Fund.
lodging, camp nursing care (except lice treatments), program supplies (few exceptions),
and activities (except “optional programs”).                                                           OPTIONAL BUS AND BAGGAGE SERVICE - Camp Cayuga provides bus transportation and
                                                                                                       baggage service 4 times during the camp season: (1) on opening day; (2) from camp at the end of
SIBLING CREDIT - Cayuga extends a discount to families who enroll 2 or more                            the first-half session; (3) to camp at the beginning of the second-half session; and (4) from camp at
children. The tuition is credited $400 for each additional sibling enrolled for the full-              the end of the full season. This service caters to the areas of New York, New Jersey, Philadelphia,
season and $300, $200, and $100 for the 6-week session, half-session, and 2-                           and Maryland. The charge for this optional service is $160 round trip (or $85 one-way), except for
week session respectively. The shorter session is used to determine the credit.                        White Marsh, Maryland which is $170 round trip (or $90 one-way).
There is no sibling credit for a stay less than 2 weeks.
                                                                                                       OPTIONAL SPECIAL AIRPORT TRANSPORTATION SERVICE - Cayuga provides transportation
CANTEEN FUND - The Canteen Fund is the only mandatory charge in addition to                            to/from 4 airports on the first & last day of each session. A Senior Staff Member will personally
the camp tuition. The Canteen Fund charge is $250 (full-season), $170 (6-week                          escort your child to/from the terminal gate. The roundtrip charge per child is $120 ($60 one-way) for
session), $140 (half-session), $110 (first & last 2-week mini session), and $60                        Scranton Wilkesbarre Airport (Avoca, Pennsylvania), $180 ($90 one-way) for Newark International Airport
(second & third 2-week session). The Canteen Fund covers: one official Camp                            (New Jersey), $210 ($105 one-way) for LaGuardia International Airport (Flushing, New York), and $210
Cayuga T-shirt, Weekly Laundry Service, Cayuga DVD Yearbook, Cayuga                                    ($105 one-way) for JFK International Airport (Jamaica, New York). If the camper’s flight date is
Calendar, Daily Allowance of $1.50 for snack purchases at the camp store, Off-                         scheduled on any date other than an official camp session date, an extra fee will be added to the
Season Newsletters, and Admission Fee/Bus Transportation to Dorney Amusement                           Airport Service fee as follows: Newark Airport (extra $30 one-way) and LaGuardia/JFK Airport (extra
Park & Hershey Park. Full season campers attend both Amusement Park trips.                             $50 one-way). We discourage both LaGuardia Airport and JFK Airport for travel-time purposes. If
Campers enrolled for: 6-weeks, half-session, first 2-weeks, and the last 2-week                        you request this service, an Airport Transportation Itinerary Form must be completed. The Airport
mini-session attend one Amusement Park trip. There is no Amusement Park trip                           Transportation Itinerary Form is accessible on-line at www.campcayuga.com/forms, or go to “Camp
during the second & third 2-week mini-sessions. Since the total cost of the canteen                    Forms” on Cayuga’s website.
items exceeds the amount charged, there is never a prorated refund of the
Canteen Fund. Note: Do not confuse the Canteen Fund with your camper’s Camp                            OPTIONAL PROGRAMS: PRIVATE TENNIS LESSONS, ATV QUAD RIDING, SCUBA DIVING,
Bank, which holds for safekeeping your child’s “spending money” used for personal                      PAINTBALL & ACADEMIC TUTORING - Regularly scheduled daily activities (like horseback riding) are
expenditures and to cover the nominal fee for optional day trips (baseball games,                      included in the camp tuition. Optional Programs including private tennis lessons, paintball, ATV quad
local theatre trips, and golf course trips).                                                           riding, academic tutoring, and scuba diving clinics are not included in the tuition and require advance
                                                                                                       registration. Registration forms for Optional Programs (as well as optional services & trips) are
REFUND OF PAYMENTS - FOR FIRST TIME CAYUGA CAMPERS: Campers                                            accessible on-line at www.campcayuga.com/forms, or go to “Camp Forms” on Cayuga’s website.
enrolling for their first summer are extended Cayuga’s First-Time Camper
                                                                                                       CONDITIONS OF ENROLLMENT - Camp Cayuga strives to provide positive camp experiences for
Guarantee, which provides a refund of the camp tuition for the days not attended
                                                                                                       children with various needs whenever possible. However, Camp Cayuga does not provide programs
by the camper due to an early departure. The parent must abide by the camp
                                                                                                       that are rehabilitative or therapeutic in nature, and does not specialize in serving children with special
policies regarding early departure procedures for the First-Time Camper Guarantee
                                                                                                       needs, including children with emotional, social, or behavioral difficulties. Please provide information
to apply. Tuition refunds are based upon the actual session the camper attends
                                                                                                       (attach a separate sheet) regarding your child’s special needs, including any disabilities, disorders or
camp. Example #1: If a camper enrolls for the full-season and departs camp at the
                                                                                                       medical problems with this application form. It is important to determine if Camp Cayuga is
end of the first-half session, the first-half session tuition is charged (not one-half of the
                                                                                                       appropriate for your child prior to attending camp. Failure to provide adequate information prior to
full-season tuition). Example #2: If a camper enrolls in the 6-week session (40 days)
                                                                                                       your child attending camp may result in the camper being sent home without a refund. Camp
and departs camp on the 30th day, the first-half session tuition is charged (for the first
                                                                                                       Cayuga cannot accept children who do not have the promise of living cooperatively with others.
27 days) in addition to a prorated portion of the third 2-week session tuition (for the
remaining 3 days at camp).                                                                                  If a separate sheet has been attached to this enrollment application, check this box.
FOR RETURNING CAMPERS: No tuition refund is granted when a returning                                      I understand & certify that my child’s participation in Camp Cayuga and its activities (on or off-
camper departs camp with 14 days or less remaining in the camper’s enrolled                            camp) is completely voluntary and I have familiarized myself with the camp's program and activities
session. If a returning camper departs camp with 15 days or more remaining in the                      in which my child will be participating. I recognize that certain hazards and dangers are inherent in
original enrolled session, the camp will refund one-half of the tuition balance after                  the Camp’s programs particularly, but not limited to: horseback riding, ATV quad riding, lake & pool
deducting the ordinary charges for the period the child remained in camp. Example                      swimming, ropes course, rock climbing, zip line, hiking on mountain trails, back packing, cabin
#1: If a camper enrolls for the full-season and departs at the end of the first-half                   overnights, canoe/tubing trips, circus acts, flying trapeze, tetherball, gymnastics, cycling on mountain
session, the charge is the first-half session tuition plus one-half the difference                     trails & public roads, land & water sports, water slides, baseball, lacrosse, cheerleading, archery,
between the full-season tuition (original session) and the first-half tuition (new session).           riflery, athletic competition including bodily contact and contact with equipment and balls, intercamp
Example #2: If a camper enrolls in the first-half session (27 days) and departs on                     games, inline skating, skateboarding, scuba diving, paintball, bungee trampoline jumping, use of
the 11th day, the charge is the first 2-week session tuition prorated for 11 days plus                 power tools and equipment in certain creative arts activities, and travel in camp-owned and leased
one-half the difference between the first-half tuition (original session) and the first 2-             vehicles. I acknowledge that, although Camp Cayuga has taken safety measures to minimize the risk
week tuition prorated for 11 days (new session). Example #3: If a camper enrolls in                    of injury to camp participants, the Camp cannot insure nor guarantee that the participants,
a 2-week session and departs before the end of the session, the charge remains                         equipment, premises and/or activities will be free of hazards, accidents or injuries. I recognize these
the same. Again, there is no refund when a returning camper departs camp with                          risks and hereby assume these risks and agree to hold harmless and hereby release Camp Cayuga,
14 days or less remaining in the camper’s enrolled session.                                            its directors, owners, agents, and employees from all liability for loss, damage, injury or illness to the
FOR ALL CAMPERS: Refunds are mailed after the camp season but before                                   camper or camper’s property related to his/her participation in the camp program. Furthermore, I
September 30th. Tuition fees and refunds are based upon the actual session(s) the                      have instructed my child in the importance of knowing and abiding by the camp’s rules, regulations
camper attends camp. Any discounts and/or credits relating to the actual session                       and procedures for the safety of all camp participants, and the requirement that campers must
are applied. If a camper arrives late to camp, no tuition credit or canteen credit is                  attend scheduled activities and remain supervised at all times, and my child has agreed to do so.
given for the missed days. Cayuga reserves the unrestricted right to dismiss,                             Camp Cayuga is not responsible for articles of clothing or personal belongings said to be lost or
without a refund, any camper who exhibits emotional, psychological or behavioral                       damaged by fire, theft or laundry.
conditions that are disruptive to the camp program or that are harmful to himself or                      Permission to use the camper’s photo/video/comments in brochures, video tape, DVDs, and/or
the well being of other campers or staff.                                                              other promotional media is granted.
                                                                                                          Permission is granted to publish the camper’s email address in the camp’s Pen Pal Email Directory,
CANCELLATIONS - Cancellations received on or before April 30th incur a $250                            unless otherwise indicated on the reverse side of this application.
fee. Enrollments that are cancelled after April 30th incur a $500 fee. All remaining                      A finance charge of 1.5% per month (18% annually) will be applied to all outstanding debts.
payments will be refunded.                                                                             Accounts which have not been paid in full will be subject to attorney fees (at least $1500) and costs of
                                                                                                       the court and collection.
CAMPER TREATMENT AUTHORIZATION & MEDICAL INSURANCE - Infirmary                                            It is agreed that any dispute or cause of action arising between the parties, whether out of this
medical care is provided as part of the camp tuition (except for lice/nits treatments).                agreement or otherwise, can only be brought in the PA Court of Common Pleas located in Wayne
Certain illnesses and/or injuries are referred by the Infirmary Staff to outside                       County, Pennsylvania, and shall be construed in accordance with the laws of Pennsylvania. If the
medical professionals whose fees are not covered by the camp’s tuition or canteen                      Camp is successful in any litigation, it is agreed that the losing party will reimburse the Camp for all
fund. If it is necessary, in the judgment of the Camp Director, to use outside                         attorney fees and costs of litigation.
medical, surgical, or dental aid for the camper's health, the parent(s) or legal                          The parent(s) or legal guardian hereby states that the camper is in good, normal health and has no
guardian hereby authorizes him to obtain this medical care and further agrees to                       abnormal physical or mental handicaps unless otherwise indicated on the aforementioned attached
pay for the medical services provided, including any medical expense not covered                       sheet. The parent(s) or legal guardian hereby states that the camper is of sufficient maturity to
by the parent’s/legal guardian’s medical insurance policy. All campers are required                    properly care for his/her hygiene and participate in the camp’s program.
to carry medical insurance.


I have read this enrollment application and agree to its terms and conditions. If this application is signed by one parent, I acknowledge that I am also acting as the agent of the other parent with the authority to enroll my
child at Camp Cayuga and to execute this agreement on his or her behalf. I recognize that Camp Cayuga relies upon the representations made in this application in accepting this enrollment.


 SIGNATURE OF PARENT/GUARDIAN:______________________________________________________ DATE:_______________________
                                              A PARENT’S SIGNATURE AND A DEPOSIT OF $500 IS REQUIRED TO PROCESS THIS APPLICATION
                              RETURN TO: CAMP CAYUGA SUMMER OFFICE, 321 NILES POND RD, HONESDALE, PA 18431. TELEPHONE: (570) 253-3133. FAX: (570) 253-3194.
                                                         WEBSITE: WWW.CAMPCAYUGA.COM * EMAIL: INFO@CAMPCAYUGA.COM
                                   WINTER BUSINESS OFFICE: CAMP CAYUGA, PO BOX 151, PEAPACK, NJ 07977. TELEPHONE: (908) 470-1224. FAX: (908) 470-1228.

								
To top