Pathfinder Country Day Camp Enrollment Form 2023
Pathfinder's Online Enrollment System for 2023
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Email *
How did you hear about Pathfinder? *
Camper First & Last Name *
Child's Birthday *
MM
/
DD
/
YYYY
Check One *
Required
Camper age (June 2023) *
Years & Months
September 2023 Grade *
Gender *
Parent/Guardian Name *
Cell Phone # *
Home Phone # *
Winter Mailing Address *
Street/Apt#,City,State,Zip
Parent Contact #1 *
Email, Cell #, Work #
Parent Contact #2 *
Email, Cell #, Work #
Emergency Contact #1 *
Name, Cell #, Work #
Emergency Contact #2 *
Name, Cell #, Work #
Permission to Pick Up Child #1 *
Name?  Relationship to Child?  Does camper know this person?
Permission to Pick Up Child #2 *
Name?  Relationship to Child?  Does camper know this person?
Summer Street Address *
House #, Street Name, Town: MTK AMG EH  
PATHFINDER DOES NOT PROVIDE TRANSPORTATION  Parent Drop Off/Parent Pick Up Only
Camper Swim Ability *
Fishing: Children ages 8 years - 12 years only
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Insurance Company *
Policy Number *
Group Number *
Relationship to Participant/Primary Card Holder *
Food Allergies? *
Required
Animal/Insect/Other Allergy? *
Required
Does your child have asthma?
List medications required at camp.
 *
Required
Dietary Restrictions *
Required
Medical Forms: Current physical, including a copy of child’s immunizations, is mandatory prior to children beginning camp. All physicals must be dated within a 12 month period of attendance. Children who are not immunized must have a written letter of explanation for the health office file.
Campers Last Well Check by a Licensed Medial Personal? *
Date (__/__/__)
Activity Restrictions *
Children who are not immunized must have a written letter of explanation for the Suffolk County Health Department.
Mandatory to attend camp: Well-Check Within 12 Months/Copy of Camper Immunization Record
Email this document to nbsummercamp@msn.com With the subject title being the child's First and Last name then immunization record
Permission to Photograph Child for Advertising Purposes *
Please place my child with friends. Children are grouped by age, grade and gender. 
Names of children placed together.
 *
Full Season Dates
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Weekly Options: 5 days / week 
Consecutive weeks
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Weekly Options: 4 days / week  
Consecutive weeks, please.
Sibling Discount
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Camper Begin date?  End date?  *
Tuition Includes: Backpack, T-shirt, Friday Cookouts, Professional Shows, Events Calendar, Friends and Fantastic Summer Days!
A deposit of $950 is due per child when enrolling. This will secure camper space for summer 2023. Payment in full is due May 1st, 2023. The balance will be charged to your credit card on file May 1st, 2023.
Please follow below instructions to submit enrollment form correctly.
1. Submit deposit/payment (payment link below)
2. Credit card must match billing/address information.
3. Return to this form to finalize Terms, Conditions, Medical Information below.
Click link above, enter Credit card payment information and tuition amount. Below: Camper Tuition Amount
I give permission for Pathfinder to charge my credit card for any balance due after May 1st, 2023. *
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