SELF-RELIANCE • RESOURCEFULNESS • THE WILL TO ACHIEVE • SERVICE TO OTHERS

Online Enrolment Application

Name: Phone:
Nickname: Cell:
Birthdate (Month/Day/Year): Height:
Grade Camper Will Enter Next Fall: Weight:
Address: Camper Age on July 1:
Zip: Years
Parent's Email: Months
Camper Email:    

Session Applying For (check one)




For Six weeks, Check the First Two Sessions

Highest Level of Red Cross/YMCA Swimming Level Achieved:
Father's Name: Occupation:
Business Address: Phone:
Mother's Name: Occupation:
Business Address: Phone:
Summer Address: Phone:
Dates at Summer Address: From To

Please Provide the Name of a Teacher Who Is Able to Give a Camper Recommendation:

(We will forward the necessary forms. Returning campers omit.)

Teacher's Name: School Phone:
School Address: Zip:
Teacher's Home Address: Home Phone:
Grade:    

To Assess the Effectiveness of Promotion, Please Share How You Heard About Roaring Brook:

So that we may do our best in working with your son at camp, we ask that you reply to the following questions.
The Roaring Brook program has assisted many boys in their personal growth, but it is not designed as a therapeutic course. It is simply an experience for boys who are excited about learning outdoor skills and enjoying a true outdoor adventure. If necessary you may attach additional sheets. Thank you very much for your assistance.

What do you wish your son to gain from his experience at Roaring Brook?

Are there areas in which your son has particular difficulty? These might be physical limitations, learning or attention deficit disorders or simply low self-esteem in relation to peers. If so, is he receiving help in these areas? Please note: Parents must inform the camp, in advance, of any medications their son is taking to assist with these difficulties or medications taken for medical problems to determine if the camp can accommodate their medication schedule. Campers must be physically capable of participating in a highly active program.

How does your son interact with other children individually or in a group? Please note: Roaring Brook cannot accommodate boys with any history of social or behavioral disorders that have caused problems at home or school.

When a boy comes to camp from a home that is undergoing change (new location, separation, divorce etc.) his experience is often affected. Are any of these changes a part of your son's life, and if so, how is he adapting?

This information will be shared with the counselors who will be living with your son. It will allow them to better meet your goals for your son's growth and his physical needs, social interaction skills and personal learning style at camp. We consider ourselves part of a team dedicated to your son's development in self-reliance, resourcefulness and the will-to- achieve in life, as well as learning and enjoying exciting outdoor skills.

I Have Read and Agree to All the "Registration Terms of Agreement" as Stated in the Literature.

This Application Has My Approval:

Date: