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Campers bringing flounder home for dinner

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

2009 Application........ $435.00 per week 

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______________________________________________

Amount to put on credit card   $____________.   Special for 2009  - A deposit of at least $50.00 is due at time of registration.  Then, please make up to 4 payments (monthly or every other month) until camp begins.  Your final payment will be due on the first day of your child's camp.

And my choice of the following week/weeks.......Teens can attend any week, not just the specified "teen weeks".

The cost for this special week is $435.00.  On Tues. July 7th we will be taking the teens by boat to see the Tall Ships in Boston Harbor.  We plan on leaving the dock at 6:30AM and returning late in the day.  Breakfast, snacks and beverages will be included.  There will be no camp on Wed. July 8th.  The regular teen schedule will resume on Thursday, July 9th.

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.  ___________________________________________
___________________________________________________________________________