Camper Enrollment Form

Please fill out our enrollment form below to complete your camper registration, and remember these requirements must be satisfied for a camper to attend first day of camp:

• The camper must be the child or grandchild of a Sagamore Beach Colony Club member. If the member’s current season dues are unpaid, the camper may be placed on a wait list if camp enrollment capacity has been met or exceeded.
• A current health form, prepared, signed and dated by a licensed health care provider within the 12 months prior to the first day of camp attendance must be uploaded for a camper to be eligible to attend camp.

Please complete this form for each child registered in the Sagamore Beach Day Camp.

• Participant Information

• Camper Name*
  First Last
• Birth Date*
  MM slash DD slash YYYY
• Shirt Size*
  • Child Extra Small
  • Child Small
  • Child Medium
  • Child Large
  • Adult Small
  • Adult Medium
  • Adult Large
• Swim Level*
  • Can not swim
  • Novice
  • Intermediate
  • Advanced
• Allergies*
  Please check all that apply.
  • Drug
  • Food
  • Pet
  • Insect
  • None
• Allergy Explanation
  If you did not select "none" above, please use this space to provide a description of the allergen(s).
• Medication*
  Does your child require medication to be administered during camp hours? (This includes the possible administration of an EpiPen) If yes, except for an EpiPen, medication must be administered by a parent and arranged by contacting the Camp Director.
  • Yes
  • No
  • Epipen
• Health Insurance Info*
  Please provide health insurance information to include insurance company name, phone number, and policy number.

• Parent/Guardian Information

• Parent/Guardian Name*
  First Last
• Parent/Guardian Email*
  Please provide primary parent/guardian email address for this youth. This email address will receive the camp email communication.
  Enter Email Confirm Email
• Parent/Guardian Mobile Number*
  If parent/guardian does not have a mobile number, please fill in the primary phone number.

• Summer Address

  Please provide address where the camper resides while attending camp.
• Summer Address*
  Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code
• Summer Phone*
  Please provide home phone number where the camper resides during camp.

• Parent/Guardian Authorization Statements

• Image Release*
  Do you authorize the SBCC Day Camp and/or Jr. Tennis Program to use images of your child for the purpose of (1) the Camp video to be shown and sold at the Camp Show (2) the Camp's Group picture distributed to all campers (3) the Jr. Tennis pictures captured seasonally and (4) the Camp and Jr. Tennis photo gallery maintained on the SBCC website?
  • Yes
  • No
• Hospital Release*
  In the event of a medical emergency, if a parent/guardian cannot be reached, do you authorize the SBCC Day Camp and/or Jr. Tennis Program to secure the necessary emergency medical treatment for your child and transportation to the nearest hospital by licensed paramedics of the Town of Bourne?
  • Yes
  • No
• CPR Release*
  Do you understand that the Camp's Director and counselors are trained in the basics of First Aid and are CPR certified and thereby authorize the Director or counselors to provide first aid and/or CPR to your child when appropriate?
  • Yes
  • No
• Raft Permission*
  Do you authorize the SBCC Day Camp to allow your child the option to swim to the raft located at the public beach? Please be aware that a trained lifeguard employed by the camp is on duty during camp swim times, and at least one counselor will be in the water for every 10 campers in the water, however the counselors employed by the Camp are not trained in water safety. This option is not given to campers in Groups 1 and 2.
  • Yes
  • No
• Unaccompanied Dismissal*
  Do you authorize the SBCC Day Camp to release your child from camp at 12:55PM to walk or ride his/her bike home without parent/guardian supervision or assistance? Please note that all children riding bikes to camp are required to have a helmet.
  • Yes
  • No

• Dismissal Names

  Please provide up to 4 persons to whom you authorize the SBCC Day Camp to release your child at the camp dismissal time. This is not a required field.
• Dismissal 1 Name
  First Last
• Dismissal 1 Phone
• Dismissal 2 Name
  First Last
• Dismissal 2 Phone
• Dismissal 3 Name
  First Last
• Dismissal 3 Phone

• Emergency Contacts

  In the event of a medical emergency, please provide 2 persons to whom you authorize the SBCC Day Camp to contact if the parent/guardian cannot be reached.
• Emergency 1 Name*
  First Last
• Emergency 1 Phone*
• Emergency 2 Name*
  First Last
• Emergency 2 Phone*

• Final Step

  Thank you for providing the details in this registration form. At the bottom of the form, click Submit and wait for the confirmation to appear on your screen.
• 
  
• Comments
  This field is for validation purposes and should be left unchanged.