2008 Camper Application for Admission

Last Name:   First Name:

Middle Name:   Preferred Name:

Date of Birth (mm/dd/yy):   Age at Camp:

Rising Grade in School:   Gender   Male   Female

Alumni of The Green River Preserve? Yes   No     Years:

First Choice Please Select Mini Base Camp Session Base Camp Session 1 Base Camp Session 2 Base Camp Session 3 Base Camp Session 4 Blue Ridge Expeditions 1 Blue Ridge Expeditions 2 Blue Ridge Expeditions 3 Outer Banks Expeditions 1 Outer Banks Expeditions 2 Outer Banks Expeditions 3   Second Choice Please Select Mini Base Camp Session Base Camp Session 1 Base Camp Session 2 Base Camp Session 3 Base Camp Session 4 Blue Ridge Expeditions 1 Blue Ridge Expeditions 2 Blue Ridge Expeditions 3 Outer Banks Expeditions 1 Outer Banks Expeditions 2 Outer Banks Expeditions 3

Mailing Address:

City:   State:   Zip:

Email:

Telephone:     Cell Phone:

Billing Address (If Different from Above):

City:   State:   Zip:

Father's Name:

Occupation:

Business Phone:   Cell Phone:

Email:

Mother's Name:

Occupation:

Business Phone:   Cell Phone:

Email:

Alternate Contact Person:

Relationship:   Phone:

Cell Phone:   Email:

School Name:

School Address:

City:   State:   Zip:

Phone:

Email:

Principal/Headmaster/Headmistress:

Homeroom teacher or teacher reference:

Why did you choose this program?

What would you personally like to get out of this experience?

Please tell us about any hobbies or special interests that you have.

What are you looking forward to the most at GRP?

Have you attended any other camps? If yes, please tell us the names of the camps and how many years you attended.

Although I realize that it may not be possible, I would like to be in a cabin with:*

*Cabin Requests (Base Camp Campers only.) Cabin assignments are made according to age and grade level to insure compatible levels of maturity. We recognize that there may be reasons for exceptions to this policy, such as maturity beyond, or not up to, a camper's chronological age. Where such is the case, parents should inform us prior to the time of enrollment so that a proper cabin assignment can be made. The directors reserve the right to make the final decisions on cabin assignments. We cannot guarantee placement in any particular cabin. Campers frequently want to be in the same cabin with a friend. We are glad to honor such requests when given by both campers and parents, provided the campers are of the same grade and age and the assignment does not result in an excessive number of campers from the same city. Requests should be made on the camper application.

Camper Agreement: If I am accepted, I promise to conform to the rules and regulations of The Green River Preserve or face possible dismissal. I confirm this promise by filling out my name and the date below.

Camper Signature:   Date:

Does your child wish to attend this program? Please explain if the answer is no.

Please list relatives who have attended GRP:

Are camper's parents both living? Yes   No   Living Together? Yes   No

If separated, with whom is the child living with?

Names & Ages of Siblings.

Should our staff be aware of any educational, family, or psychological issues concerning this student? Please explain if "yes".

Does your child have any pre-existing medical conditions? If yes, please identify the condition.

Is your child taking any medications? If yes, what are they?

Does your child take medication during the school year that he/she may not take during the summer? If yes, what are they?

Does your child have any allergies?

Does your child have any dietary restrictions?

Does your child swim? Yes   No

Has your child completed any swimming certifications?

Please share with us what benefits you hope your child will gain from The Green River Preserve:

Parent Comments: Please include any suggestions that will be helpful to the staff in giving your child a happy, worthwhile camp experience.

Friends  Who: 

Family  Who:

Internet     School   Publication Ads Which One:

Home or School Presentation  Where:

Camper Rep  Name of Rep:

Other  Please Specify:

I would like to recommend Green River Preserve to:

Child's Name:   Address:

City:   State:   Zip:

Parent's Name:

Child's Name:   Address:

City:   State:   Zip:

Parent's Name:

I understand that no deposit is required with this application, but that if my child is accepted, I will:

Pay 25% of the tuition within two weeks of receiving notification of acceptance.

Pay 25% of the tuition by February 1, 2008.

Pay the tuition balance by April 1, 2008.

Applications submitted after April 1st pay full tuition upon acceptance.

Fees not covered by tuition:

Camp store purchases. We recommend a credit line of $25 per week. Optional Base Camp backpack rental of $10 for one week session and $20 for two and three week sessions.

The deposit is applicable to the tuition and is, in the event of withdrawal, refundable, less a $100 processing fee, if written notice is received by the camp office by April 1, 2008. No refunds will be made after April 1, 2008 for early withdrawal, session changes, late arrivals, or no-show campers, except in the event of documented physical illness of the camper. In such event, 50% of the unused portion of the tuition will be refunded.

Return campers do not need a completed Teacher Recommendation form. Acceptance notification will be mailed within three weeks of receipt of the application. We are a small camp with limited enrollment, so applications should be submitted as soon as possible to ensure space in our program. A health form will be sent with the parent packet. It requires signature by parents and a physician. All campers must provide a completed health form prior to the camp session. Also, campers must provide proof of coverage by health insurance.

In addition to personal checks, we now accept Visa and MasterCard.

Scholarships of up to 30% of the camp tuition are available based on financial need. Scholarship application forms are available upon request from our office. A scholarship application and a copy of your tax return must be mailed to us to be considered for a scholarship.

Scholarships are awarded on a first come basis. Early application for scholarships is encouraged.

  Please check the box if you would like to receive a scholarship application.

We, the undersigned parents (or guardians) of the camper named on the application (herein referred to as "the child"), acknowledge that we are aware of the types of activities in which the child will be participating during his or her attendance at The Green River Preserve (herein referred to as "GRP") during the 2008 season. We also acknowledge that we have been given ample opportunity to ask any questions which we may have about the environment in which the child will live and the activities in which he or she will participate during his or her attendance at GRP. We are aware of the dangers which are inherent in the operation of any children's camp and in the child's participation in the activities at GRP during the 2008 camp season. Specifically, but not by way of limitation, the undersigned consent to the child's participation in all camp activities on or off the premises of said camp including swimming, hiking, backpacking, canoeing, kayaking, athletics, arts and crafts, work and service projects, stream hiking, outdoor living skills, camping, archery, BB skeet, fly fishing, rock climbing, and vehicular travel.

We further acknowledge that we have given GRP full disclosure of any physical or mental conditions, challenges or problems which the child has. Because of the inherent potential dangers of participating in the activities of any children's camp, we recognize the importance of the child's obeying the instructions of camp employees and abiding by all camp rules and regulations. We have instructed the child to obey said employees and then abide by said rules and regulations, and we do hereby release GRP and its owners, the officer, directors, board members, and all of the staff, counselors, and other employees of GRP from any liability which they might otherwise incur as a consequence of the failure of the child to obey said employees and abide by said rules and regulations from any other liability which said camp and the other parties listed above might otherwise incur in incidents involving the child's negligence or contributory negligence.

If outside medical services (x-rays, labs tests, etc.) should be needed, we understand that we are financially responsible. We grant permission to: (1) Use photographs and video that include our child for camp advertising. (2) Use our name and phone number as a reference for prospective campers.

Parent Agreement: If my child is accepted, I agree to the terms defined above. I confirm this promise by filling out my name and the date below.

Parent Signature:   Date:

If you have a digital photo of your camper, please upload a copy with this application. (A photo will help us identify your camper on opening day.) Uploading a photograph is optional.

File: