Coutts Summer Camp
2022 Registration Form
Mail this
completed form and a check for the deposit to: PO Box 565 Derby VT 05829
Campers
Name _______________________________ Age _____ Gender ________ Phone
_______________
Parents
Name ______________________________________
Address
________________________________________________________
All
forms will be sent to this email Please print clearly. Email ______________________________________________
If
overnight preference for a bunk buddy or any special requests ____________________________________
Check
which week or weeks your camper will be attending:
Day
Camp offerings ages 5-13
Deposit
$30 non-refundable
$190/wk $145/wk reduced rate
__ Week 1
June 20-24
__ Week 2
June 27-July1
__ Week 3
July 11-15
__ Week 4
July 18-22
__ Week 5
July 25-29
__ Week 6
Aug 1-5
Overnight
offerings ages 8-12
Deposit
$60 non-refundable
$330/wk $250/wk reduced rate
__ Week 2
June 27-July1
__ Week 3
July 11-15
__ Week 5
July 25-29
Bear
Cub Science ages 3-5
Deposit
$30 non-refundable
$85/wk. $70/wk reduced
rate.
__ Week 1
June 20-24 8:30-11:30am
__ Week 2
June 27-July1 8:30-11:30am
__ Week 3
July 11-15 8:30-11:30am
__ Week 4
July 18-22 8:30-11:30am
__ Week 5
July 25-29 8:30-11:30am
__ Week 6
Aug 1-5 8:30-11:30am
Teen
Overnight Camps
Deposit
$100 non-refundable
__ CIT
Camp Week 1 June 22-24 ages 13-15 $200/wk
__ Teen
Adventure Camp Week 3 July 11-15 ages 12-15 $370/wk
Mail
deposit and this form to PO Box 565 Derby, VT 05829
Annie
& Jason Brueck
802-673-5638