Coutts Summer Camp 2025 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:

**Deposits are required for each week your camper is attending**

 

Day Camp offerings ages 5-13                                

Deposit $50 non-refundable.  $200/wk    $150/wk reduced rate    Drop off 8-8:30 pick up 4-4:30  Friday pick up 2pm      

__ Week 1 June 16-20

__ Week 2 June 23-27                       

__ Week 4 July 7-11                                      

__ Week 5 July 14-18

__ Week 6 July 21-25

__ Week 7 July 28-Aug 1

 

Overnight Camp offerings ages 8-12

Deposit $100 non-refundable. $375/wk    $300/wk reduced rate Drop off Mon 8-8:30 Friday pick up 2pm

__ *Week 3 June 30-July 3 *(4 days, pick-up Thur 2pm cost is $275 or $250 reduced rate)

__ Week 4 July 7-11

__ Week 6 July 21-25

           

 

Bear Cub Science ages 3-5                                      

Deposit $30 non-refundable       $90/wk.  $75/wk reduced rate.                                        

__ Week 1 June 16-20  8:15-11:15am

__ Week 2 June 23-27  8:15-11:15am

__ Week 5 July 14-18  8:15-11:15am

__ Week 7 July 28-Aug 1 8:15-11:15am

 

Teen Overnight Camps

Deposit $100 non-refundable

__CIT Camp Week 2 June 25-27 ages 13-15 $250/wk drop off Wed 8-8:30 pick up Fri 2pm

 

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

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