Pine Island Camp Registration Form 2022
Thank you for choosing Pine Island Camp! To register your son for our 2022 season, please fill out the form below, read and accept the terms, sign, and click the Submit button. This application is not a binding agreement until you have received a personal confirmation of enrollment from the Director, at which time the $750 tuition deposit should be sent to Camp:

Pine Island Camp
P.O.Box 242
Brunswick, ME 04011

2022 Camp Dates are: Friday, June 24 - Sunday, August 7. Tuition for the 2022 season is $9,500 if registered by November 30th; $9,750 if registered after November 30th; and $10,000 if enrolled in our Expedition Camp program.

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Camper's First Name *
Camper's Last Name *
Name he goes by (if different)
Grade to be completed spring 2022 *
Age on June 24, 2022 *
Date of Birth *
Parent/Guardian #1 Name *
Parent/Guardian #1  Cell Phone *
Parent/Guardian #1 Home Phone
Parent/Guardian #1 Email *
Parent/Guardian #1 Street Address *
Parent/Guardian #1 City, State Zip *
Parent/Guardian #2 Name
Parent/Guardian #2 Cell Phone
Parent/Guardian #2 Home Phone (if different than Parent #1)
Parent/Guardian #2 Email
Parent/Guardian #2 Street Address (if different than Parent #1)
Parent/Guardian #2 City, State Zip (if different than Parent #1)
Other Contact Person, Relationship, and Phone number
Have you met with Camp Director Sumner Ford? *
Sumner meets with all new camp families.
Required
Would your son like to enroll in our Expedition Camp program?
In addition to our traditional camp program for boys ages 9 - 15, we also offer Expedition Camp.  Our Expedition Camp program is designed for 15- and 16-year-olds who are interested in leadership training.  It's an intensive program that teaches boys trip planning and takes them on extended camping trips. Please note that the tuition for Expedition Camp is $10,000.
How did you learn about Pine Island Camp? *
If you learned about camp from a specific person, please tell us who it was.
Comments/Questions
If you have any comments or questions, please enter the information here.
Please Read the Following Terms
Expectations and Standards
The camper and parents agree to abide by all of the rules and policies established by Pine island Camp (the Camp), including without limitation those relating to enrollment and withdrawal, and agree that trust, communication, honesty and integrity are keys to a successful Camp community.
2022 Payment terms/schedule
Tuition for the 2022 season is $9500 if registered by November 30th, $9750 if registered after November 30th, and $10,000 if enrolled in the Expedition Camp program. All families also pay $200 towards an incidental account (any unused portion of this account is refunded at the end of the September). We offer a sibling discount of $500 per additional child. Our payment schedule is as follows:

To reserve your child's place at camp, a nonrefundable deposit of $750 is due with your son's completed registration form.
On February 1, half of the remaining tuition is due.
On May 1, the tuition balance and incidental account deposit are due.
Withdrawal
If a camper withdraws before May 1, all tuition and fees, excluding the $750 non-refundable deposit, will be refunded.  Between May 1 and June 1, half of the tuition and fees, excluding the $750 non-refundable deposit, will be refunded. Parents are responsible for the entire tuition if a camper withdraws after June 1.
Dismissal
At the sole discretion of the Director, the Camp reserves the right to send home at any time during the season, without tuition reduction or refund, any camper whose behavior or demeanor is determined by the director to be unacceptable or detrimental to the best interests of the Camp or Camp community.
Code of Conduct
The Camp does not tolerate physical or psychological abuse or punishment of any kind. Bullying and other forms of harassment or abuse will result in disciplinary action, which may include dismissal, at the discretion of the Director.

Medical Care
Parents hereby grant the Camp permission to provide onsite routine medical care (including, but not limited to, treatment of minor wounds and illnesses). Parents hereby grant the Camp permission to obtain non-routine medical care (including, but not limited to, dental, orthodontic, and optical care) from qualified medical professionals where necessary. Parents also hereby grant the Camp and its employees to provide and/or consent to emergency medical procedures at any location during the Camp season without prior notification to the parents. Parents are responsible for all medically related expenses incurred on behalf of their child that are not delivered by camp staff.
Permission to Participate
Parents hereby grant their son permission to participate in Camp activities, excursions, and wilderness trips. Parents acknowledge that Camp programs will take place in outdoor and wilderness settings and that there is a risk of serious physical injury inherent in participation in programs in such settings.
Force Majeure
The Camp is not responsible for delayed commencement, early termination, non-operation of any camp program, or other itinerary changes caused by weather, unusual water levels, strikes, political or diplomatic changes or other causes beyond the Camp’s control.
Publication
Parents hereby grant the Camp permission to copyright or publish photographs, movies, videos, letters or tape recordings of their son and to use those images in camp publications, promotional materials, camp website, and any other camp-related promotional materials or projects. Children will not be identified by name on the website or in the brochure.
Belongings
The Camp is not responsible for camper’s belongings or equipment while in transit or at Camp.
Electronics
Campers are allowed to bring portable listening devices with them to Camp; however, campers may not bring cell phones and they may not use any electronic devices to play games or watch video of any kind. Any electronic devices being misused will be impounded until the end of the season.
Visitation
Apart from our farewell celebration at the end of the Camp season, to which all are invited, the Camp does not have a scheduled visiting day. However, parents are welcome to arrange a visit to Camp at any time during the season, provided such is arranged with the director before visiting.  The Camp cannot provide housing for visitors.

Non-Discrimination
It is the Camp’s policy to admit campers without regard to race, religion, sexual orientation, national origin, or ethnic origin.
Release and Indemnity
By signing below, Parent, for himself, herself, his/her spouse or co-parent, and on behalf of the Camper,
agrees: a. to release and not to sue the Camp and/or its Board of Directors, employees, other staff and representatives and contractors (“Released Parties”) with respect to any and all claims, demands, actions, causes of action, damages, injuries or losses of any kind (collectively “claims”) arising in whole, or in part, from Camper’s enrollment, attendance and participation in Camp activities and movement about the Camp premises and use of its facilities and equipment; and b. that these agreements of release and not to sue include, but are not limited to, claims based in whole, or in part, on the
negligence (but not gross negligence of intentionally wrongful conduct) of a Released Party.
By signing here, you acknowledge that you have read, understand, and accept all of the terms and conditions above.  Please note: This application is not a binding agreement until you have received a personal confirmation of enrollment from the Director, at which time the $750 tuition deposit should be sent to Camp.
Parent/Guardian Electronic Signature *
By selecting the "I Accept" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. *
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