Please Fill Out & Complete All Fields
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In accordance with the Children's Online Privacy Protection Act a person must by 13 years of age or older to complete and submit this form.

* denotes required field.

Camper Information

New Camper - Welcome!

Sibling (Selecting this instructs us to use duplicate information from a siblings enrollment form.)

Returning Camper (Selecting this instructs us to use information from last year. Below, simply make any updates, including grade, addresses, phone numbers and health info/medications along with all required fields.)

Special Event / The Other Wedding Party

First Name: *
Last Name: *
Gender: Boy Girl *
Date of Birth: *
Height:
Weight:
Eye Color:
Hair Color:
Date of Last Physical:
Camper's Primary Language: *
Present Grade: *
Grade in September 2017: *
Name of Camper's School:
 
Parent / Guardian (1) Full Name: *
Parent / Guardian (2) Full Name:
 
Camper's Primary Address: *
City: *
State: *
ZIP: *
Home Phone: *
Please tell us how you heard about BDC:
Please list the names and relationships of the people with whom the camper resides:
Name:
Relationship to Camper:
Age:
 
Name:
Relationship to Camper:
Age:
 
Name:
Relationship to Camper:
Age:
 
Name:
Relationship to Camper:
Age:
 
Medical Information
Known Allergies:
 
Food and/or Dietary Restrictions:
 
Please tell us about all medical conditions, physical disabilities, health concerns, or significant medical history
 
Has your child been diagnosed with any learning and/or social/emotional challenges?
YES NO
If yes, please explain:
 
Does your child take medication on a daily basis?
Yes No
If yes, please list all medications:
 
Please list all medications and/or treatments to be administered
by the camp nurse:
 
For what purpose is the medication prescribed?
By Whom:
 
Health Insurance Company:
Policy Number:
Physician Name:
Physician Phone Number:
Dentist Name:
Dentist Phone Number:
 
Contact Information
Does the camper reside with both parents? Yes No
If no, Please describe custody arrangements:
Parent/Guardian (1)
Mailing Address:
(If different than Camper's Primary Address)
City:
State:
ZIP:
Home Phone:
Occupation:
Place of Employment:
Work Phone:
Cell Phone:
Email address: *
 
Parent/Guardian (2)
Mailing Address:
(If different than Camper's Primary Address)
City:
State:
ZIP:
Home Phone:
Occupation:
Place of Employment:
Work Phone:
Cell Phone:
Email address:
 
Cape/Other Address:
(If different than Primary)
City:
State:
Zip:
Best Other Phone
(If different from parent/guardians)
:
Please mail Camp Information to
(pick one):
Camper's Primary Address
Parent/Guardian (1)
Parent/Guardian (2)
Cape/Other Address
 
Please mail Billing Information to
(pick one):
Camper's Primary Address
Parent/Guardian (1)
Parent/Guardian (2)
Cape/Other Address
Camper Success
Detailed information will help us enrich your child's camp experience. Please take the time to give us current information on
your child, even if s/he attended BDC in past years. All information will be kept confidential. Thank you.
On a scale of 1-5, how much do you agree with the following statement about your child?  
My child has strong endurance. (disagree) 1 2 3 4 5 (agree)
My child enjoys group games/playing on teams. (disagree) 1 2 3 4 5 (agree)
My child makes transitions easily. (disagree) 1 2 3 4 5 (agree)
My child thrives in a dynamic, fast paced & stimulating environment. (disagree) 1 2 3 4 5 (agree)
My child enjoys gross motor activities (biking/sports). (disagree) 1 2 3 4 5 (agree)
My child enjoys fine motor activities (art/books). (disagree) 1 2 3 4 5 (agree)
My child makes friends quickly and easily. (disagree) 1 2 3 4 5 (agree)
My child is comfortable in the water (Red Cross Swim Level ). (disagree) 1 2 3 4 5 (agree)
Please tell us how we can best support your child at camp?
 
Emergency and Pick Up Information
In case of an Emergency please notify:
Name: *
Relationship: *
Best Phone: *
The following people have permission to pick up my child from camp:
Name:
Relationship to Camper:
Phone:
 
Name:
Relationship to Camper:
Phone:
 
Name:
Relationship to Camper:
Phone:
 
Name:
Relationship to Camper:
Phone:
 
Enrollment

BDC 2017 Rates

October 16, 2016− May 1, 2017
Half Tuition to Hold Spot or by Payment Plan
May 2, 2017− Aug. 18, 2017
Full Tuition Required to Hold Spot
5 Days (MTWThF)
$585
4 Days (Week #2 only)
$475
3 Days (MWF or TWTh)
*Under 5's Only
$465
2 Days (TTh)
*Under 5's Only
$335
Single Day & Customized
*Under 5's Only
$195
Enrollment Fee
$60
* Full-Summer Registration *
$4095 + $0 Enrollment Processing Fee (Week #2 Free!)
Sibling Discount
5% off Additional Siblings N/A after 5/1/2017
Local Student Scholarships
5% of Total Family Tuition N/A after 5/1/2017
EXTRA LESSONS
Golf, Tennis, Semi-Private Swim & Stand-up Paddle Boarding $45 Horseback Riding $99, Sailing School: 2-Day $125 or 4-Day $250, Surf School $155
WATER WIZZ Add Trip to Camp Day $85  or Trip & Camp Day: $185
BDC AFTER DARK $75
Week 1 June 26-June 30
Friday Special Event BDC Birthday
Schedule Options
Full Week M-F
Partial-Week Session (children under five only)
Click here if you accidentally enrolled for this week  
Extras
Standup Paddle Boarding M
Semi-Private Swim Lessons M
Semi-Private Swim Lessons T
Semi-Private Swim Lessons Both M and T
Tennis Tuesday
Riding Wednesday
Golf Thursday
Sailing School 2 Days MW
Sailing School 2 Days TTh
Sailing School 4 Days MTWTh
Week 2 July 3-July 7
(CLOSED: Tuesday, July 4th - National Holiday)
Friday Special Event Grad-Titude Day
Schedule Options
Full Week (4 Days) MWThF
Partial-Week Session (children under five only)
Click here if you accidentally enrolled for this week  
Extras
Stand Up Paddle Boarding M
Semi-Private Swim Lessons M
Riding W
Golf TH
Sailing School 1 Day Th
Sailing School 2 Days MW
Sailing School 3 Days MWTh
Week 3 July 10- July 14
Friday Special Event Creative Arts Day
Schedule Options
Full Week M - F
Partial-Week Session (children under five only)
Click here if you accidentally enrolled for this week  
Extras
Standup Paddle Boarding M
Semi-Private Swim Lessons M
Semi-Private Swim Lessons T
Semi-Private Swim Lessons Both M and T
Tennis Tuesday
Riding Wednesday
Golf Thursday
Add Water Wizz Trip (Thursday) Enrolled for Day
Add Water Wizz Day (Thursday) Not Enrolled for Day
Sailing School 2 Days MW
Sailing School 2 Days TTh
Sailing School 4 Days MTWTh
Week 4 July 17- July 21
Friday Special Event Green & White Day
Schedule Options
Full Week M - F
Partial-Week Session (children under five only)
Click here if you accidentally enrolled for this week  
Extras
Standup Paddle Boarding M
Semi-Private Swim Lessons M
Semi-Private Swim Lessons T
Semi-Private Swim Lessons Both M and T
Tennis Tuesday
Riding Wednesday
Golf Thursday
Sailing School 2 Days MW
Sailing School 2 Days TTh
Sailing School 4 Days MTWTh
Week 5 July 24-July 28
Friday Special Event Wear Your Tie-Dye
Schedule Options
Full Week M - F
Partial-Week Session (children under five only)
Click here if you accidentally enrolled for this week  
Extras
Standup Paddle Boarding M
Semi-Private Swim Lessons M
Semi-Private Swim Lessons T
Semi-Private Swim Lessons Both M and T
Tennis Tuesday
Riding Wednesday
Golf Thursday
Add Water Wizz Trip (Thursday) Enrolled for Day
Add Water Wizz Day (Thursday) Not Enrolled for Day
Sailing School 2 Days MW
Sailing School 2 Days TTh
Sailing School 4 Days MTWTh
Week 6 July 31 - August 4
Friday Special Event Olympic Day
Schedule Options
Full Week M - F
Partial-Week Session (children under five only)
Click here if you accidentally enrolled for this week  
Extras
Standup Paddle Boarding M
Semi-Private Swim Lessons M
Semi-Private Swim Lessons T
Semi-Private Swim Lessons Both M and T
Tennis Tuesday
Riding Wednesday
Golf Thursday
Sailing School 2 Days MW
Sailing School 2 Days TTh
Sailing School 4 Days MTWTh
Week 7 August 7-August 11
Friday Special Event Carnival Day
Schedule Options
Full Week M - F
Partial-Week Session (children under five only)
Click here if you accidentally enrolled for this week  
Extras
Standup Paddle Boarding M
Semi-Private Swim Lessons M
Semi-Private Swim Lessons T
Semi-Private Swim Lessons Both M and T
Tennis Tuesday
Riding Wednesday
Golf Thursday
Add Water Wizz Trip Enrolled for Day
Add Water Wizz Day Not Enrolled for Day
Sailing School 2 Days MW
Sailing School 2 Days TTh
Sailing School 4 Days MTWTh
Week 8 August 14-August 18
Thursday Special Event Player's Performance
Schedule Options
Full Week M - F
Standup Paddle Boarding M
Partial-Week Session (children under five only)
Click here if you accidentally enrolled for this week  
Extras
Semi-Private Swim Lessons M
Semi-Private Swim Lessons T
Semi-Private Swim Lessons Both M and T
Tennis Tuesday
Riding Wednesday
Golf Thursday
Sailing School 2 Days MW
Sailing School 2 Days TTh
Sailing School 4 Days MTWTh
Form of Payment
You are welcome to contact our office for assistance in calculating your Account Balance. After we have received 1/2 tuition and enrollment fee, we will send a statement for your review listing all remaining charges and payments applied to this account. Questions regarding enrollment or billing should be directed to our winter office staff, at 888-396-CAMP(2267) or info@brewsterdaycamp.com
Camper Name:
Paying Adult:
Please note that this Online Enrollment will not be processed until proper payment is received.

Payment by check or money order payable to Brewster Day Camp

I understand that my child's enrollment is on hold until my proper payment is received by the BDC Office. Half payment plus the Enrollment Fee is required to secure my child's space at camp and full payment is due by May 1, 2017.

Please send checks or money orders to:
Brewster Day Camp, PO Box 40052, Providence, RI 02940 Please write camper(s) name on the memo line of all checks.

Payment by credit card. BDC accepts VISA, MASTERCARD & AMERICAN EXPRESS.

I understand that half payment plus the Enrollment Fee is required to secure my child's space at camp and full payment is due by May 1, 2017. I agree to pay the $60 Enrollment Fee at this time, with the remainder of tuition due to be charged by BDC after my schedule is confirmed.

Card Type: Visa Master Card American Express

Amount to charge on credit card:
Name on Card: First and Last Name ONLY Please
Card Number: ex: 0123456789101234
Exp. Date: ex: 0120 = January 2020
Security Code: ex: 123

Billing Address:
City:
State:
Zip Code:

Other (Gift Certificate, CCN Voucher, The Other Wedding Party, etc.) 

Please specify:


Financial Agreement and Release

My child, * has my permission to go on all field trips sponsored by Brewster Day Camp. In the event of sickness or accident, when parents or guardian can not be readily contacted, I authorize the calling of a physician, transporting of my child, and/or the providing of other necessary medical services including emergency transportation at my expense. A qualified staff person may administer first aid to my child. I give the Registered Camp Nurse my permission to administer Tylenol to my child if the nurse deems it necessary. The Emergency Names listed on this form may be contacted to support my child or take him/her from camp as noted above. I will have an updated copy of my child’s health records on file at camp prior to or by June 1, 2017. I give permission to Brewster Day Camp to use photographs taken of my child solely for promotional purposes. I give Brewster Day Camp permission to publish my family name, telephone number, and address in a camp directory for use only by camp families and staff.

My son/daughter/ward is enthusiastic and prepared to participate in all Brewster Day Camp programs. Furthermore, the undersigned agree that should the applicant’s conduct, at the sole discretion of Brewster Day Camp, be in violation of the rules or otherwise detrimental to the maintenance of standards or to the successful operation of a Brewster Day Camp program, the applicant may be removed from the program, either for a part of a day, for a day, or several days, or for the remainder of the camp season, in which event there will beno refund of the tuition fee.

The undersigned agree to pay the tuition, fees, and other charges incurred by the camper as set forth on this Enrollment Form and to pay the camp’s costs and expenses of collection and attorney’s fees if this account is placed for collection. The failure to pay tuition will render the camper ineligible to attend Camp or its functions. The undersigned has enclosed a non-refundable enrollment fee. The undersigned has read and agrees to the “Tuition and Payment Policies” as described in the accompanying materials.

I understand that in the event of the withdrawal, dismissal, or absence of the camper after May 1, 2017, no portion of the tuition fee will be refunded, waived, or exchanged by the Families Schools Inc. and/or Brewster Day Camp. There will also be no refund to families or guardians whose camper is withdrawn or is dismissed during the camp season. I understand that all outstanding balances will automatically be charged to my credit card.

I have read and agree to all the terms of “Agreement” as well as the description of the program as stated in the promotional materials. No employee or agent of the camp has the authority to modify or supplement the Agreement.

Please Note: A drop or change made to the above schedule before May 1, 2017 is free for the first change. A $50.00 fee will be applied to each reduction or change of schedule thereafter. Simply adding time or EXTRAS to the above schedule will not incur a change fee. AFTER MAY 1, 2017, NO REFUNDS OR SCHEDULE CHANGES WILL BE GRANTED FOR ANY REASON.


* I agree