Coutts Summer Camp 2023 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 26-30                                   

__ Week 2 July 3-7                                        

__ Week 3 July 10-14                                    

__ Week 4 July 17-21

__ Week 5 July 24-28

__ Week 6 July 31-Aug 4

 

Overnight Camp offerings ages 8-12

Deposit $60 non-refundable. $350/wk    $275/wk reduced rate

__ Week 2 July 3-7

__ Week 4 July 17-21

__ Week 6 July 31-Aug 4

 

Bear Cub Science ages 3-5                                      

Deposit $30 non-refundable       $85/wk.  $75/wk reduced rate.                                        

__ Week 1 June 26-30 8:30-11:30am                        

__ Week 1 June 26-30 1-4pm            

__ Week 3 July 10-14 8:30-11:30am                        

__ Week 3 July 10-14 1-4pm

__ Week 5 July 24-28 8:30-11:30am

__ Week 5 July 24-28 1-4pm

 

Teen Overnight Camps

Deposit $100 non-refundable

__ CIT Camp Week 1 June 28-30 ages 13-15 $250/wk

__Teen Adventure Camp Week 3 July 10-14 ages 13-15 $370/wk

 

Mail deposit and this form to PO Box 565 Derby, VT 05829

programs@siskinea.org   Annie & Jason Brueck   802-673-5638