Massachusetts Summer Camp | Coastal Discoveries

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By filling out this form we will reserve a spot for your child while we wait for you to send the Official Application and your payment.

Coastal Discoveries
55 Hay Street
Newbury, MA 01951
Tel. 978-462-8859 Fax. 978-499-7735

* Required fields
Name *
E-mail Address *
M/F *
Mailing Address:
City:
State:
Zip Code:
Home Phone: *
Emergency telephone #: *
Birth Date: "Must be 9 or older"
Swimming Ability
How many weeks? Note: Teens can attend any week or the "Teen Only" week.
	June 22 - 26
	June 29 - July 3
	July 6&7 9&10 Teens Only "Tall Ships" on July 7th in Boston Harbor
	July 13-17
	July 20-24
	July 27-31 Teens Only
	Aug 3-7
	Aug 10-14
	Aug 17-21
	Aug.24-28
Has your child completed the Mass. State Safe Boating Course? *
Do you give your permission for your child to enroll in the Mass. State Safe Boating Course.
Permission for Coastal Discoveries to use Photos, Video of your child or children.
I would like my child to receive a Coastal Discoveries T-Shirt adult sizes: Please add $15 per shirt when sending your deposit.
List any allergies or medications that need to be taken during program hours or any special needs your child may have.
Questions and Comments

I have read and agree to the Privacy Policy *

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New for 2009: Send $50-$100 with the application. You may then make 3 more payments 1-2 months apart. The final payment of no more than $200 will be due on the first day of your child's week of camp.

When sending your reservation money please remember to include $15 for each TShirt.

Print and send the application with your payment please.

Coastal Discoveries
55 Hay Street
Newbury, MA 01951
Tel. 978-462-8859 Fax. 978-499-7735

Captain Bob's Cell Phone 978-815-6160

Lee's Cell Phone 978-479-1632

Fishing Charters Newburyport

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