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Print Application
Campers bringing flounder home for dinner
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Print Information Sheet
If you are unable to print from the website please contact us and we will send you an application.
Coastal Discoveries
55 Hay Street
Newbury, MA 01951
Tel. 978-462-8859 Fax. 978-499-7735
2008 Application.................................Fee $425.00 per week + $10.00 fuel surcharge
Name:______________________M/F____Parent/Guardian________________________
Mailing Address:__________________________________________________________
E-Mail________________________HomePhone: __________________
Emergency telephone #__________________________________________
Birth date:________________Must be 9 or older Swimming Ability__________________________
Enclosed is deposit of $__________or please provide credit card inf.. (Mastercard or Visa)
Credit card #____________________________Expiration date: (MM/YY)______________
Name on card______________________________________________________
Billing address for card______________________________________________
And my choice of the following week/weeks.......
| June 23-27 |
no openings |
July 28-Aug. 1 |
no openings TEENS ONLY
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| June 30- July 4 |
no openings
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Aug. 4-8 |
no openings |
| July 7-11 |
no openings |
Aug. 11-15 |
no openings |
| July 14 -18 |
no openings |
Aug. 18-22 |
no openings |
| July 21-25 |
no openings |
Aug. 25-29 |
no openings |
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Note: Teens may attend any week, not just the specified teen week.
Mass. State Safe Boating Course (must be 12 or older). Check if already completed_______
I give permission to enroll my child who is 12 years old or older in the Mass. State Safe Boating Course. Taught aboard the boat, my child will learn navigation, boat handling, and how to be a safe, responsible boater. Successful completion of this class with a passing score will result in a Mass. State Safe Boating Certificate issued by the Mass. Environmental Police. I understand this course is incorporated into the weeks activities, will not detract from any group activities and is offered at no additional fee. X____________________________________
Photo release: I give permission for Coastal Discoveries to use photographs or video of my child taken during camp for their advertising or promotional use either via their website or for print advertising. X______________________________________.
T-Shirt order: I would like my child to receive a Coastal Discoveries T-Shirt, adult sizes,
SM____MED____LG_____. Please add $15.00 per shirt with your deposit payment.
Medical release and consent: I authorize any attending physician to administer emergency care to my child in the event of injury while participating in Coastal Discoveries. I understand that my child is participating in this program under his/her own risk. My child has permission to participate in camp activities held aboard the Erica Lee II and on the program’s additional boats which may include dories and a small skiff. I will not hold Coastal Discoveries responsible should injury or loss occur. X______________________________________.
List any allergies or medications that need to be taken during program hours or any special needs your child may have. ___________________________________________
___________________________________________________________________________
Thank you for being part of our 20th anniversary adventure!
