Camp Winnebago for Boys
Application For Enrollment - Summer of 2011

Name

Present Age

Birth date

School Attending

Current Grade

Name camper likes to be called

Social Security Number

Camper's home address

Home Telephone number

Home Fax number

Email (camper)

Previous camp attended

Parents

Parents are   Living Together Living Separately

Mailing name of parents/guardian
(Mr., Mrs., Ms., Dr., etc.)

Father 

Father's name

Home address (if different from camper's)

Home phone (if different from camper's)

Occupation

Father's Email

Business address

Business phone

Fax

Mother 

Mother's name

Home address (if different from camper's)

Home phone (if different from camper's)

Occupation

Mother's Email

Business address

Business phone

Fax

Siblings 

Please list siblings names, birthdates, and camps they are attending.

I have friends who are interested in Camp Winnebago.
Please send information to :

Enrollment 

Payments 

A non-refundable tuition deposit of $2500.00 is due with this application.  A second payment of $2500.00 is due February 1.  The balance is due by May 1, 2011.  Included in tuition are canteen, transportation from and to Portland airport, laundry, linens, health & accident insurance and photographs. For 13 - 15 year olds, there is an extra amount for bike, kayak, and other trips.   Any outstanding balance will incur interest at the rate of 1.5% per month from 5/1/10 if not received by 5/31/11.  Please make checks payable to “Camp Winnebago” and return to:

CAMP WINNEBAGO
131 Ocean St
South Portland, ME 04106
Tel.(800) 932-1646; (207) 767-1019
Fax: (207) 767-1018
 

Camp Winnebago will also accept VISA or MASTERCARD for your deposit payment.
Any Credit Card payment will not be processed online.  The information is will be sent to the camp office for processing.  Please charge the deposit of $2500.00 now.

Credit Card Type Visa MasterCard

Credit Card Number 

Credit Card Expiration Date

Terms 

It is understood and agreed that campers are enrolled for the entire session and that no reduction will be made for late arrival, absence, or withdrawal, unless the vacancy is filled, except in cases of extended illness, when an equitable and mutually satisfactory adjustment will be made.  I/we understand that Camp Winnebago reserves the right to make changes, additions and deletions to its program, activities and personnel.

Camp Winnebago reserves the right to dismiss any camper due to inappropriate behavior including, but not limited to, behavior which is consistently disruptive to his peers and/or the general community, the use of tobacco, alcohol, or non-medically authorized drugs, or any other reason that in the sole discretion of the Director is not in the best interests of the camp in which case no deduction or return of the fee, or any part thereof, will be made. Winnebago is not responsible for additional costs related to the early camper departure.
It is agreed that any dispute or cause of action concerning, relating, arising out of or referring to the subject matter of this contract shall be resolved exclusively by binding arbitration in Maine according to the then existing commercial rules of the American Arbitration Association and the substantive laws of that state.”
In the event I/we cannot be reached in an emergency when my/our son is under Camp Winnebago supervision, I/we hereby give permission to the physician selected by the Camp Director to hospitalize, secure proper treatment for, and to order injections, anesthesia or surgery for my son.

My/our son has permission to participate in all camp programs, camp trips and special outings planned and/or supervised by Camp Winnebago.  If consent is needed for a particular activity and I/we are not available, I/we authorize Camp Winnebago to contact the person or persons mentioned as my/our emergency contacts on the medical form.  I/we give Camp Winnebago permission to reproduce and publish any photograph, video or other likeness of my/our son for advertising, commercial or other camp purpose.

I have read and agree to the above terms.