2014 Monomoy
3057 Main St., PO Box 1880, Brewster MA 02631
monomoydaycamp@capecodseacamps.com
508.896.3451 ph / 508.896.8272 fax
Days A-Way Application
CAMPER AND FAMILY INFORMATION– RETURN BOTH SIDES
Camper’s Name: ____________________________________________________________________________________
Last
First
Middle
Nickname
Male
Female
__________/_______/___________________________________________________________________________________________________________________________________________
Birthdate (Month/Day/Year)
Age in June
Grade completed in June
Camper Email
Current School
CheckOne:_____________________________________________________________________
Resides with: Both Parents
Mother
Father
Other – Legal Guardian - Name
Dr. Mr. Mrs. Ms. _____________________________________________________________________________________________________________________________________________
Circle One
Parent #1 First Name
Last
Street Address
City, State, Zip
Country
_____________________________________________________________________________________________________________________________________________________________
Parent Profession
Home Telephone
Work Telephone
Cell Telephone
Email
Dr. Mr. Mrs. Ms. _____________________________________________________________________________________________________________________________________________
Circle One
Parent #2 First Name
Last
Street Address
City, State, Zip
Country
_____________________________________________________________________________________________________________________________________________________________
Parent Profession
Home Telephone
Work Telephone
Cell Telephone
Email
________________ _____________________________________________________________________________________________________________________________________________
Camper Summer Address - Parent First Name
Last
Summer Street Address
Summer City, State, Zip
Summer Telephone
_____________________________________________________________________________________________________________________________________________________________
Who or how were you referred to CCSC?
Name of any family member a CCSC staff or camper?
Years at camp?
_____________________________________________________________________________________________________________________________________________________________
Billing Name (If different)
Street Address
City, State, Zip
Country
Relationship to Camper
_____________________________________________________________________________________________________________________________________________________________
Telephone
Email
Please check if you would like duplicate mailings sent to the address.
_____________________________________________________________________________________________________________________________________________________________
Emergency Contact Name #1 (If Parents are unavailable)
Telephone
Emergency Contact Name #2 (If Parents are unavailable)
Telephone
SESSION INFORMATION (Choose a session)
NON-REFUNDABLE REGISTRATON FEE: $500. US DEPOSIT REQUIRED WITH EACH APPLICATION
CAMPERS - AGES 8-13
Tuition
_____ DAW 4 July 21 – July 25
$1125
_____ DAW 1
_____ DAW 2
_____ DAW 3
June 30 – July 4
July 7 – July 11
July 14 – July 18
$1125.
$1125.
$1125.
_____ DAW 5 July 28 – August 1
_____ DAW 6 August 4 – August 8
_____ DAW 7 August 11 – August 15
$1125.
$1125.
$1125.
*CAMPERS MAY ENROLL IN A MAXIMUM OF THREE WEEKS OF DAW*
PAYMENT OPTIONS ~ Please indicate below how you wish to make payment.
This authorizes CCSC to complete the transaction as specified below in accordance with all U.S. law.
PAYMENT BY CHECK: Payable to Cape Cod Sea Camps. If you pay by check, you are permitting CCSC to convert your check into a one-time electronic debit from your bank account.
PAYMENT BY CREDIT CARD: MasterCard_______ Visa_______ Cardholder Name:_______________________________________________________________________
Card Number:_________________________________________________________________________ Expiration Date______________ Security Code ________________
AMOUNT TO CHARGE ON CREDIT CARD ~ Payment plans available, contact the business office upon registration.
______ REQUIRED REGISTRATION FEE $500. (Minimum Required Payment) and PRIOR YEAR BALANCE DUE (if any); OR
______ TOTAL TUITION AMOUNT including Registration Fee, Canteen Deposit, JC Activity Fee if applicable and PRIOR YEAR BALANCE DUE (if any) OR
______ SCHEDULED PAYMENT PLAN Authorization to charge credit card listed for Registration Deposit, February and April Tuition Payments, and Final Balance Due.
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Camper Name:_______________________________________________________________
BASIC FINANCIAL INFORMATION
WAITING LISTS Applications are accepted until space is filled in each of the Units. At that
time a waiting list is started with names added as completed applications and the required
deposit are received at the camp office. No names will be placed on the waiting list without a
completed application on file. If we are unable to confirm a registration, we will refund the
entire registration fee.
Lost and Found returned articles, medical charges are posted to your child’s account and not
included in the tuition charge.
REFUND POLICY
Before Feb 1
After Feb. 1
REGISTRATION FEE A $500. Non-Refundable Fee in US FUNDS must accompany each
application with the understanding it is applicable toward the tuition.
TUITION FINAL TUITION PAYMENTS ARE DUE ON APRIL 1. No refunds are granted
for cancellations after APRIL 1. Failure to meet the April 1st deadline may result in
cancellation of enrollment at camp. Tuition discounts will be forfeited if tuition is not paid in
full by 4/1. No reduction in tuition will be made for not using transportation or meals; arriving
late, absences, suspensions, dismissal, withdrawals or departing early; withdrawal due to
camper or parent “homesickness”. Any changes in enrollment after April 1 st or
withdrawals after the start of the camp session will forfeit the full camp fee.
After April 1
After April T
No penalty for weeks changed/dropped.
Changes in enrollment are accepted without penalty, less the
Registration Fee, prior to 2/1. After Feb. 1 if a change in enrollment
occurs, there will be a $50. Cancellation fee incurred for each week
dropped.
No Refunds Available.
TUITION DISCOUNT FORFEITURE – If tuition is not received on
April 1, all tuition discounts are forfeited.
FIDUCIARY RESPONSIBILITY FOR TUITION The parent or guardian whose signature
appears on the child's application form is responsible for tuition payments
Refer to Financial Information and Parent Handbook for details
CANTEEN ACCOUNT Any expenses incurred at camp will be itemized on a Canteen
account. Personal expenditures such as optional trips, special camp clothing, store charges,
PARENT AGREEMENT
It is important that campers and parents have full understanding of, and be in agreement with
the overall Cape Cod Sea Camps philosophy, ideals and goals related to group living and
community involvement.
I understand Cape Cod Sea Camps program is an active, outdoor, group living experience
of a positive and constructive nature. The program requires full and complete participation
from all campers.
I understand Cape Cod Sea Camps reserves the right to determine whether or not a child is
able to meet the physical and emotional rigors of camp life. I understand that Cape Cod Sea
Camps relies upon the information contained in this application form, medical information
and other forms provided on behalf of the child. The parent or guardian signing this
document assumes all risk of loss arising from information that may not be accurate or
complete and agrees to indemnify Cape Cod Sea Camps, its officers, directors, successors
and assigns against all claims for loss, damage or injuries sustained to the child and relating
to such incomplete or inaccurate information.
I understand it is required to read all materials s and complete all forms in a timely manner
required for participation at the Cape Cod Sea Camps.
I understand that there are numerous risks associated with participation in any camping
activities, including but not limited to activities such as sailing, swimming, archery, riflery,
cycling, athletics, woodworking and transportation to and from camp activities. A complete
listing of inherent and other risks is not possible and there may be some risks that cannot be
anticipated. Risks that contribute to the unique character and desirability of the activities
involved pose the possibility of severe injury, illness or death. I further understand that the
activities involved will take place in an outdoor environment and upon open water where
unalterable weather conditions may pose risks beyond the control of Cape Cod Sea Camps.
I further understand that Cape Cod Sea Camps is not a therapeutic program or
treatment center.
PERMISSION TO PARTICIPATE - My child may use, under the supervision of camp staff,
hazardous equipment involved in but not limited to activities such as Woodworking, Archery,
Riflery, Cycling etc. My child may participate in any trip or activity sponsored and supervised
by Cape Cod Sea Camps on or off the campus, and may travel when deemed necessary by
the program via public carrier or vehicles leased or operated by Cape Cod Sea Camps. I
give permission for my child to participate in all camp activities including those described on
this form. I acknowledge and assume the risks involved in these activities and for any
damage, illness, injury or death resulting from such risks for myself and my child. There are
no physical, emotional, mental problems or limitations associated with my child’s
participation in camp activities, except as disclosed by me in writing to Cape Cod Sea
Camps.
I understand, unless otherwise stated, permits camp to use photographs or video pictures of
my child taken in the course of the program for publicity of camp or the American Camp
Association.
EMERGENCY AUTHORIZATION - In the event I cannot be reached in an emergency, I
hereby give permission to the physician selected by the camp director to hospitalize, secure
proper treatment for, and order injection, anesthesia, or surgery for my child named above.
I understand In the event of misconduct or other circumstances, Cape Cod Sea Camps
reserves the right, in its sole discretion, to expel a camper before the completion of the
session in which the camper is enrolled.
I understand weapons and firearms are not permitted, with the sole exception of the camp’s
supervised instructional programs in archery and riflery, using equipment provided by camp.
CAMPER EXPECTATIONS
It is important for our camp families understand our basic expectations and rules for behavior
for your campers as a member of our camp community. Please review and discuss the
Camper Expectations with your child, signing the enrollment application to
acknowledge agreement.
As A Camper I Will:

Know and abide by the Camper Code of Conduct or Junior Counselor Code of
Conduct (refer to Parent Handbook) which covers but not limited to the following:
o
Alcohol and other drugs;
o
Sexual Harassment and Sexual Behavior;
o
Verbal, Emotional and Physical Harassment and Bullying;
o
Inappropriate Language;
o
Personal Presentation;
o
Off-campus Behavior;
o
Boundaries and Curfews;
o
Core Values.

Show respect to other Campers, and treat them as well as I would like to be treated.
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Respect the rights and beliefs of others, and treat others with courtesy and
consideration.
Communicate in an appropriate manner, which means I must not use foul language or
gestures, harsh words, demeaning comments or harsh tone of voice. Conduct myself
responsibly. I understand that unwelcome teasing or other unkind behaviors are not
allowed.
Refrain from deliberately causing bodily harm to others. I understand that pushing,
kicking, hitting or fighting are not acceptable and will not be tolerated.
Respect the property of others; which includes not stealing, property damage, graffiti,
or vandalism.
Be fully responsible for my actions and understand that irresponsible behavior will
result in disciplinary action or dismissal from camp.
Let an adult know if someone is bullying me.
Let an adult know if I witness someone else being bullied (reporting is confidential).
Know and abide by the Policies and Procedures as outlined in the Parent Handbook.
PARENT SIGNATURE (REQUIRED)
PARENT/GUARDIAN SIGNATURE (REQUIRED): I have read and accept all of the terms and conditions set forth on BOTH SIDES of this Enrollment Application. I AGREE with and
have read and discussed the “Camper Expectations” with my camper.
Parent/Guardian Signature_______________________________________________________________________________________________________
PRINT NAME________________________________________________________________________________________________Date_______________