Coutts Summer Camp Registration Form 2026

2026 Coutts Camp Registration Form

This form includes all basic info, emergency and medical info, and the wavier.  We will not need to email you any forms this year!! We hope this one step process works, fingers crossed! You will have the options for online payments or mail a check. We have a Welcome to Coutts Camp letter and Pack list available on our Camp page of our website.

Does your child have any medical conditions, allergies, special concerns, extra guidance needed, etc., that Coutts should be aware of? If there are food allergies please provide specifics around severity – for example cooked, uncooked, consumption only or issues if skin contact, etc
List any campers you would like to bunk with in the cabins. Also any other important info.
Please list all possible medications your camper will take while in camp and what time of day they will need the medications. We typically do meds at breakfast, lunch, dinner, or bedtime. Include directions for Epipen if they will have one on site.
Please list an insurance company and your campers policy number

Coutts-Moriarty Camps, Inc. Assumption of Risk Agreement for Participants 

PLEASE READ CAREFULLY BEFORE SIGNING Dear Coutts-Moriarty Camps, Inc. participants and families, During your program with Coutts-Moriarty Camps, Inc. you will be outside in wild and semi-wild settings. It is our job as counselors, educators and guides to do all we can to protect you, but there are objective risks of getting hurt in all of what we do. We at Coutts-Moriarty are well prepared, however, we are people too, and may make mistakes. Besides the potential for human mistakes, there are also natural events such as storms and sometimes those events are more powerful than we are. By signing this agreement you acknowledge that in exchange for the privilege of participation in Coutts-Moriarty programs, you accept all of the known and unknown risks involved. Furthermore, you acknowledge that as an individual you are responsible for your own safety and agree to use common sense and exercise thought before actions. Depending on a participant’s age and the abilities of the individual person Coutts- Moriarty recognizes that there are different expectations regarding levels of responsibility. Under NO circumstances should a camper be in possession of any illegal or dangerous materials, use abusive language, and/or take part in dangerous or abusive behavior. This will not be tolerated and will result in the immediate dismissal from camp with no refund. I, for myself and on behalf of my heirs, assigns, personal representatives, and next of kin, hereby release, indemnify, and hold harmless Coutts-Moriarty Camps, Inc., its officers, officials, agents and/or employees, other participants, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event or program, from any and all claims, demands, losses, and liability arising out of or related to any injury, disability or death I may suffer, or loss or damage to person or property, whether arising from the negligence of the releases or otherwise, to the fullest extent permitted by the law.

The camper and guardian must read the Statment of risk and check the boxes above in order to register for Coutts Camp.

Payment options for Summer Camp 2026

Pay online below which includes a small fee.

OR

Pay by check : make check out to Coutts Camp and mail it to PO Box 565, Derby VT 05829

Price: $51.00
Balance due after deposit will be $170 ($130 for reduced rate) due first day of camp or before Includes transaction fee of $1.00
Price: $226.50
Includes transaction fee of $6.50
Price: $185.50
Includes transaction fee of $5.50
Price: $103.00
Balance due after deposit will be $320 ($300 for reduced rate) due first day of camp or before. Includes transaction fee of $3.00.
Price: $432.00
Includes transaction fee of $12.00
Price: $350.00
Includes transaction fee of $10.00
Price: $51.00
Balance due will be $50 due on first day of camp or before. Includes transaction fee of $1.00
Price: $103.00
Includes transaction fee of $3.00
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