HOW TO ENROLL YOUR CHILD IN DAY CAMP AT CAMP HAIASTAN
1. Read 2013 DAY CAMP PARENT & CAMPER GUIDE
2. Complete checklist items below for each camper by May 15, 2013, after this date we charge a $50 Late
Fee for enrollments received. All forms and fees must be submitted by 2-weeks prior to your camper’s
session, after this date we charge a $25 Service Fee. See camper photo requirements below, current
2” x 2” school full frontal face photos of your camper labeled with name must be mailed.
3. READ, UNDERSTAND & AGREE: Day Camp Enrollment Policies & Requirements and Legal Conflict
Avoidance & Photo/Video Release.
All forms are available at: http://www.camphaiastan.org/enroll/day-camp/ (No computer or printer? You may call
or email to request that an enrollment packet be mailed to you – see Pg. 2 for contact info.)
SUBMISSION OPTION 1 (Preferred): Complete forms online then save and submit via email.
SUBMISSION OPTION 2: Complete forms online then print them and submit via mail/ship (see Pg. 2)
SUBMISSION OPTION 3: Print forms, complete them by hand and submit them via mail/ship (see Pg. 2).
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2013 FAMILY PROFILE & INFORMATION FORM (Form #1): Submit one form per family – must be
signed by parents/guardian – this form applies for all campers from your family enrolled in both Overnight
Camp and Day Camp.
2013 DAY CAMP ENROLLMENT FORM (Form #2): Submit one form per camper – current 2” x 2”
school full frontal face photo of your camper labeled with name must be mailed.
PARENT’S PAYMENT WORKSHEET FORM (Form #3): Submit one for up to 3 campers – tells us how to
properly credit payments to your account. Minimum deposit of ½ session fee (or full payment of session
fee and Camp Store deposit). We prefer payment by personal check or E-Check or you may use your
credit card (personal/cashier checks and money orders must be mailed).
OPTIONAL CREDIT CARD & E-CHECK AUTHORIZATION FORM (Form #4): Submit one per family –
necessary only if you plan to make payments by credit card or E-Check.
IMPORTANT: PRINT & READ HEALTH RELATED FORMS CHECKLIST BEFORE SUBMITTING HEALTH
REALTED FORMS.
HEALTH HISTORY FORM 1 - 4 PGS. (Form #5): Completed and signed by parent/guardian – current 2”
x 2” school full frontal face photo of your camper labeled with name must be mailed. A separate
immunization record can be scanned and submitted by email or mailed with this form – a physical exam is
not required for Day Camp attendance. There is no Health Form 2 for Day Camp.
AUTHORIZATION TO ADMINISTER MEDICATION TO A CAMPER FORM (Form #6): Submit one form for
each medication – This form necessary only if your camper will bring medications. Each form must be
signed by parent/guardian and submitted with HEALTH HISTORY FORM 1.
Message From Board of Directors Regarding Payment Options
PARENTS PLEASE NOTE: Due to ever increasing credit card processing fees, we are asking you to consider not using
your credit card for fee payment. Rather, we are requesting you to use E-Checks or personal checks for your payments.
As an incentive, we will give away via a drawing, an Apple I-Pod Touch ($300 value) at the end of the season. You will
have a chance in the drawing for every camper whose full fees have been paid by E-Check or personal check. Thank you
in advance for helping reduce our $9,000 and growing credit card processing expense annually.
HOW TO ENROLL YOUR CHILD IN DAY CAMP Pg. 2
NO FAXED FORMS ACCEPTED – PHOTOS MUST BE SUBMITTED BY MAIL ONLY – A CAMPER MUST
NEVER ENTER INFORMATION ON ANY FORM
ALL FORMS AVAILABLE AT: http://www.camphaiastan.org/enroll/day-camp/
EMAIL electronically completed forms & scanned documents to: [email protected]
DO NOT EMAIL PHOTOS
- OR MAIL completed forms, payments and photos in a 9” X 12” or larger envelope to:
Camp Haiastan
P.O. Box C
Franklin, MA 02038
DO NOT BEND OR FOLD FORMS
(Photos only can be mailed in a standard envelope)
- OR -
SHIP completed forms, payments and photos in a 9” X 12” or larger envelope/pouch via UPS or FedEx to:
Camp Haiastan
722 Summer St.
Franklin, MA 02038
DO NOT BEND OR FOLD FORMS
Need Help With Forms? Have Questions? Contact Executive Director Baron Roy Callan 508 520-1312
9 a.m.- 5 p.m. EST Mon.- Fri. or [email protected]
WE ADVISE THAT YOU RETAIN COPIES OF ALL DOCUMENTS THAT YOU SUBMIT
2013 CAMP HAIASTAN DAY CAMP ENROLLMENT FORM
SUBMIT THIS FORM FOR EACH CAMPER BY MAY 15, 2013 ($50 LATE FEE AFTER 5/15)
ENROLLMENT FORM MUST BE SUBMITTED WITH MINIMUM ½ DEPOSIT OF SESSION FEE
SEE DAY CAMP ENROLLMENT POLICIES & REQUIREMENTS
CAMPERS MUST BE 5, 6 OR 7 YRS. OF AGE
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REQUIRED 2X2 school full frontal
face photo
PLEASE ENROLL BY CHILD IN THE CHECKED SESSION(S):
_____ Day Camp Week 1: Mon. June 24 to Fri. June 28
$395
____ Day Camp Week 2: Mon. Aug. 5 to Fri. Aug. 9
$395
____ Day Camp Weeks 1 & 2 Special Price
$600 (SAVE $190!)
Full Camper Name:_________________________________________________________________________________________
Date of Birth:________
Age While At Day Camp:______
Has Camper Ever Attended A Day Camp?_______
Gender:
OFFICE USE
School Grade Fall 2013
Is Camper New To Our Day Camp?________
“Hye Time” Armenian Program: Camper’s relative knowledge of Armenian Culture:_______________________________________
Camper’s swimming level:____________________________________________________________________________________
I wish to donate unused Camp Store Deposit balance to the Camp Haiastan Camper Financial Aid Fund:_____________________
This camp life adjustment information requested below assists us in insuring that your child has a safe, successful and enjoyable
Day Camp experience. Complete and accurate responses are required. Check all that apply to your camper and further explain
checked items in the space provided.
Slow to change before & after swimming_____ Slow eater_____ Overly sensitive (name, weight, bathroom, etc.)_____
Particular fears_____ Fear of swimming pool_____ Bathroom fears_____ Likely to be homesick_____
*Non-Medical physical challenges_____
Use space below to explain all camp life adjustment items checked
FORM #2
REQUIRED
CAMP HAIASTAN DAY CAMP ENROLLMENT POLICIES & REQUIREMENTS
Please review the 2013 DAY CAMP PARENT & CAMPER GUIDE
CAMPER PHOTO REQUIREMENT: CURRENT 2”x 2” SCHOOL SIZE FRONTAL FACE PHOTO OF YOUR CAMPER FOR:
1. DAY CAMP ENROLLMENT FORM
2. HEALTH HISTORY FORM 1
PHOTOS MUST BE MAILED – DO NOT EMAIL PHOTOS
ENROLLMENT POLICIES & AGE ELIGIBILITY REQUIREMENTS:
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Day campers must be no younger than 5 yrs. of age and no older than 7 yrs. of age at the start of their Day Camp week.
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Initial enrollment is due by May 15, 2013, a $50 Late Enrollment Fee will be charged after May 15, 2013. All fees are payable in U.S.
dollars. If you enroll your camper for Day Camp Week #1 by 5/15/2013, you may add Week #2 at a later date with no Late Fee.
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Day Camp hours are 9:30 a.m. – 3:30 p.m. each day. Camper drop off no earlier than 9:20 a.m.
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Admission to Day Camp will not be allowed without completed required forms on file and full payment submitted. All required forms and
payments must be submitted not later than 2 weeks prior to your camper’s Day Camp week otherwise a $25 Service Fee will be charged at
Registration on the first day.
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Admission to Day Camp on first day Registration requires parent and camper to attend confidential meeting with our Licensed Nurse to
review health related forms and policies (Commonwealth of Mass. law). First day Registration is 8:30 a.m. – 9:30 a.m.
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Hot lunch is provided daily at the Residential Camp dining hall. Menu is available in advance; bag lunch from home is permissible as a
substitute. Snack Time snacks are provided, snacks from home are permissible for Snack Time. (Dietary needs will be accommodated
upon request if possible.)
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Enrollment is limited to 25 campers maximum per week. We must have a minimum of 12 campers enrolled per week. To improve your
chances of securing enrollment, please apply early. Applications are processed on a “first-come” basis.
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Day Camp fee includes qualified and trained supervision with a staff-to-camper ratio of at least 1 staff to 5 campers, daily hot lunch,
snacks, camp photo, camp T-shirt and all craft materials.
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Campers must be dropped off at and picked up from the Tzamour Hall/Picnic Ground Day Camp Site. Speed limit on campgrounds is 5
MPH – PLEASE DRIVE RESPONSIBLY. You must park in the adjacent parking lot for drop off and pick up, not on the camp road.
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Parents/drivers must exit the campgrounds immediately after dropping off Day Campers. Lower Residential Camp is off limits to all Day
Camp parents or drivers of day campers.
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Camp Haiastan refuses no one for financial reasons. A confidential Request for Financial Aid Form can be obtained at
www.camphaiastan.org or sent to you on request. Confidential payment plans are available upon request. Please call the Executive
Director, Baron Roy Callan (508 520-1312) for financial aid information and confidential discussion of your need.

In the event that you cancel your application, all pre-paid fees, less $50 are refundable provided written notice of cancellation is received
not later than 2 weeks prior to your camper’s Day Camp week. No refunds for partial stays. Camp Haiastan reserves the right to dismiss,
at its sole discretion, any camper for unacceptable behavior, and no refunds of unused fees will be issued.
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Camp Haiastan maintains a racial and gender non-discriminatory policy toward applications, campers and in all activities.

This camp must comply with regulations of the Massachusetts Department of Public Health (105 CMR 430.000), and be licensed by the
Town of Franklin Board of Health. Information on CMR 430.000 can be obtained at 617 624-2000 (TDY/TDD 617 624-2001).

Publicity Disclaimer: Camp Haiastan reserves the right to display for the enjoyment of camper’s families or for promotional purposes, in
print or on the Internet, the photographic image of any person involved with the camp in the relationship of children’s camping (see
Photo/Video Release Form).
RETAIN A COPY FOR YOUR RECORDS
CAMP HAIASTAN DAY CAMP ENROLLMENT POLICIES & REQUIREMENTS
Please review the 2013 DAY CAMP PARENT & CAMPER GUIDE
CAMPER PHOTO REQUIREMENT: CURRENT 2”x 2” SCHOOL SIZE FRONTAL FACE PHOTO OF YOUR CAMPER FOR:
1. DAY CAMP ENROLLMENT FORM
2. HEALTH HISTORY FORM 1
PHOTOS MUST BE MAILED – DO NOT EMAIL PHOTOS
ENROLLMENT POLICIES & AGE ELIGIBILITY REQUIREMENTS:

Day campers must be no younger than 5 yrs. of age and no older than 7 yrs. of age at the start of their Day Camp week.

Initial enrollment is due by May 15, 2013, a $50 Late Enrollment Fee will be charged after May 15, 2013. All fees are payable in U.S.
dollars. If you enroll your camper for Day Camp Week #1 by 5/15/2013, you may add Week #2 at a later date with no Late Fee.
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Day Camp hours are 9:30 a.m. – 3:30 p.m. each day. Camper drop off no earlier than 9:20 a.m.

Admission to Day Camp will not be allowed without completed required forms on file and full payment submitted. All required forms and
payments must be submitted not later than 2 weeks prior to your camper’s Day Camp week otherwise a $25 Service Fee will be charged at
Registration on the first day.

Admission to Day Camp on first day Registration requires parent and camper to attend confidential meeting with our Licensed Nurse to
review health related forms and policies (Commonwealth of Mass. law). First day Registration is 8:30 a.m. – 9:30 a.m.

Hot lunch is provided daily at the Residential Camp dining hall. Menu is available in advance; bag lunch from home is permissible as a
substitute. Snack Time snacks are provided, snacks from home are permissible for Snack Time. (Dietary needs will be accommodated
upon request if possible.)

Enrollment is limited to 25 campers maximum per week. We must have a minimum of 12 campers enrolled per week. To improve your
chances of securing enrollment, please apply early. Applications are processed on a “first-come” basis.

Day Camp fee includes qualified and trained supervision with a staff-to-camper ratio of at least 1 staff to 5 campers, daily hot lunch,
snacks, camp photo, camp T-shirt and all craft materials.

Campers must be dropped off at and picked up from the Tzamour Hall/Picnic Ground Day Camp Site. Speed limit on campgrounds is 5
MPH – PLEASE DRIVE RESPONSIBLY. You must park in the adjacent parking lot for drop off and pick up, not on the camp road.

Parents/drivers must exit the campgrounds immediately after dropping off Day Campers. Lower Residential Camp is off limits to all Day
Camp parents or drivers of day campers.

Camp Haiastan refuses no one for financial reasons. A confidential Request for Financial Aid Form can be obtained at
www.camphaiastan.org or sent to you on request. Confidential payment plans are available upon request. Please call the Executive
Director, Baron Roy Callan (508 520-1312) for financial aid information and confidential discussion of your need.

In the event that you cancel your application, all pre-paid fees, less $50 are refundable provided written notice of cancellation is received
not later than 2 weeks prior to your camper’s Day Camp week. No refunds for partial stays. Camp Haiastan reserves the right to dismiss,
at its sole discretion, any camper for unacceptable behavior, and no refunds of unused fees will be issued.

Camp Haiastan maintains a racial and gender non-discriminatory policy toward applications, campers and in all activities.

This camp must comply with regulations of the Massachusetts Department of Public Health (105 CMR 430.000), and be licensed by the
Town of Franklin Board of Health. Information on CMR 430.000 can be obtained at 617 624-2000 (TDY/TDD 617 624-2001).

Publicity Disclaimer: Camp Haiastan reserves the right to display for the enjoyment of camper’s families or for promotional purposes, in
print or on the Internet, the photographic image of any person involved with the camp in the relationship of children’s camping (see
Photo/Video Release Form).
RETAIN A COPY FOR YOUR RECORDS
2013 CAMP HAIASTAN FAMILY PROFILE AND INFORMATION FORM
SUBMIT ONLY ONE FAMILY PROFILE & INFORMATION FORM PER FAMILY
SUBMIT WITH CAMPER ENROLLMENT FORMS – THIS FORM APPLIES TO ALL CAMPERS ENROLLED IN YOUR FAMILY
PARENT/GUARDIAN ELECTRONIC SIGNATURES REQUIRED BELOW
Parent #1 or guardian with legal custody to be contacted when necessary:
First & Last Name: ___________________________________________________ Relationship to camper:__________________________
Parent #2 with legal custody to be contacted when necessary:
Check if no Parent #2
First & Last Name: _______________________________________________________________ Relationship to camper: _________________________
Camper(s) reside with:
Both Parents
Camper’s Address: ______________________________________________ City: ________________ State:____ Zip: _________
Home Phone: _________________________________________ Preferred Family Email: ___________________________________________________
Work Phone: Father _______________________________ Mother ________________________________ Guardian _____________________________
Cell Phone: Father ______________________________Mother ________________________________ Guardian ________________________________
Emergency Contact: In the event of an emergency, we will contact a parent. Please provide an additional contact person who has agreed
ahead of time to make decisions regarding your child if we are unable to reach a parent/guardian. DO NOT LEAVE THIS BLANK
Add’l. Contact First & Last Name: _______________________________________________________ Relationship to camper: ______________________
Cell Phone: ______________________________ Home Phone: ____________________________ ___ Work Phone: _____________________________
Emergency/Mandatory Early Termination: In the event that your camper’s stay is terminated early for any reason, a parent/guardian must be
available to pickup or receive camper immediately. If no parent/guardian listed above is immediately available during camp to pickup or receive
camper due to early termination, please provide an additional contact person who has agreed ahead of time to be immediately available to pickup
or receive your camper(s) and provide care until parent/guardian can. DO NOT LEAVE THIS BLANK
Add’l. Contact First & Last Name: _______________________________________________________ Relationship to camper: ______________________
Cell Phone: _____________________________ Home Phone: ____________________________ ___ Work Phone: ______________________________
Camp Haiastan Policies, Rules, Agreements, Releases & Permissions: As parent(s)/guardian of my camper(s) and by my/our signature below,
I/we warrant that I/we and our enrolled camper(s) have read, understand and agree to abide by the following documents included with this form:
*Camp Enrollment Policies & Requirements
*Camper Behavioral Agreement
*Personal Electronic Devices Policy
**Legal Conflict Avoidance & Photo/Video Release
*Off-Campus Field Trip Permission
*Required for Overnight Camp ONLY
**Required for Overnight Camp & Day Camp
I/we agree by my/our signature below:
1. To completely, accurately and truthfully supply information required on the Camper Enrollment Form and all required Camper Health
Forms to the best of my/our knowledge.
2. That I am/we are legally responsible for my/our camper’s behavior, for my/our camper’s adherence to camp rules and policies, and for
full payment by the end of my camper’s session for all goods and services rendered during my/our camper’s attendance.
Parent#1 /Guardian Signature: _____________________________________________________ Date: ____________
Parent #2 Signature: ______________________________________________________________ Date: ____________
RETAIN A COPY FOR YOUR RECORDS
FORM #1
REQUIRED
2013 CAMP HAIASTAN DAY CAMP ENROLLMENT FORM
SUBMIT THIS FORM FOR EACH CAMPER BY MAY 15, 2013 ($50 LATE FEE AFTER 5/15)
ENROLLMENT FORM MUST BE SUBMITTED WITH MINIMUM ½ DEPOSIT OF SESSION FEE
SEE DAY CAMP ENROLLMENT POLICIES & REQUIREMENTS
CAMPERS MUST BE 5, 6 OR 7 YRS. OF AGE

REQUIRED 2X2 school full frontal
face photo
PLEASE ENROLL BY CHILD IN THE CHECKED SESSION(S):
_____ Day Camp Week 1:
Mon. June 24 to Fri. June 28
$395
____ Day Camp Week 2: Mon. Aug. 5 to Fri. Aug. 9
$395
____ Day Camp Weeks 1 & 2 Special Price
$600 (SAVE $190!)
Full Camper Name:_________________________________________________________________________________________
Date of Birth:________
Age While At Day Camp:______
no
Has Camper Ever Attended A Day Camp?_______
Gender: male
OFFICE USE
School Grade Fall 2013
no
Is Camper New To Our Day Camp?________
none
“Hye Time” Armenian Program: Camper’s relative knowledge of Armenian Culture:_______________________________________
cannot swim
Camper’s swimming level:____________________________________________________________________________________
yes
I wish to donate unused Camp Store Deposit balance to the Camp Haiastan Camper Financial Aid Fund:_____________________
This camp life adjustment information requested below assists us in insuring that your child has a safe, successful and enjoyable
Day Camp experience. Complete and accurate responses are required. Check all that apply to your camper and further explain
checked items in the space provided.
Slow to change before & after swimming_____ Slow eater_____ Overly sensitive (name, weight, bathroom, etc.)_____
Particular fears_____ Fear of swimming pool_____ Bathroom fears_____ Likely to be homesick_____
*Non-Medical physical challenges_____
Use space below to explain all camp life adjustment items checked
FORM #2
REQUIRED
REQUIRED FORM YOU MAY SUBMIT ONE FORM PER FAMILY
(You may make additional blank forms as needed)
CAMP HAIASTAN DAY CAMP PARENT PAYMENT WORKSHEET
Instructions:
1. Fill in the amount of fees, Camp Store deposits (optional) and payments for each camper, then total at the bottom and
determine your balance.
2. Minimum ½ deposit must accompany the Enrollment Application. A $50 Late Enrollment Fee is charged after May 15, 2013
(adding a second week at a later date will not incur Late Fee).
3. You must be paid in full with originals of all required forms submitted no later than 2 weeks prior to your camper’s Day Camp
week, after this date we will charge a $25 Service Fee.
1st Camper’s Name
↓
2nd Camper’s Name
↓
3rd Camper’s Name
↓
Fees – Deposits - Payments
Day Camp Week 1 $395
Mon. June 24 – Fri. June 28
__________
__________
__________
__________
__________
__________
__________
__________
__________
__________
__________
__________
__________
__________
__________
__________
__________
__________
Financial Aid or Campership Recv’d
(_________)
(________)
(________)
SUB TOTALS TODAY:
_________
_________
_________
Day Camp Week 2 $395
Mon. Aug. 5 – Fri. Aug. 9
Week #1 & Week #2 $600
Save $190!
Camp Store Deposit (optional)
$10 min./week recommended
Late Enrollment Fee $50
Enrollment app. received after 5/15/2013
Service Fee $25
Fee balance & original forms received
later than 2 weeks prior to session
GRAND TOTAL OF PAYMENTS NOW:
$__________________ FORM OF PAYMENT: __________________________
BALANCE DUE (Not later than 2 weeks prior to Day Camp week): $________________
RETAIN A COPY FOR YOUR RECORDS
FORM #3
REQUIRED
OPTIONAL FORM – SUBMIT ONLY IF YOU PLAN TO PAY BY CREDIT CARD OR E-CHECK
CAMP HAIASTAN CREDIT CARD & E-CHECK PAYMENT AUTHORIZATION FORM
PARENTS – PLEASE NOTE: Due to greatly increased credit card processing fees, we are asking you to consider not
using your credit card for fee payment. Rather, we are requesting you to use E-Checks or personal checks for your
payments. As an incentive, we will give away via a drawing, an I-Pod Touch ($300 value) at the end of the season. You
will have a chance in the drawing for every camper whose full fees have been paid by E-Check or personal check.
Thank you for helping reduce our $9,000 credit card processing expense annually.
We will accept MasterCard, Visa and American Express credit cards, plus we recommend the use of an E-Check.
To use your credit card or an E-Check, complete this form and submit it with your CAMP ENROLLMENT
APPLICATION FORM.
CREDIT CARD USE:
Cardholder Name: ______________________________________________________________________________________________
Charge Acc’t. Billing Address: _____________________________________________________________________________________
(Number and Street)
(City, State & Zip)
Credit Card Type: Visa
Acc’t. Number (PRINT CLEARLY):____________________________________________________ Expiration Date:__________/__________
2 digit month
Charge my credit card: $_______________ today.
2 digit year
Charge my credit card: $_______________ on ____________ (date)
Charge my credit card: $_______________ on ____________ (date) Charge my credit card: $ _______________ on ____________ (date)
Cardholder Signature: ________________________________________________________ Date:______________________________
==========================================================================================================
E-CHECK USE:
Checking acc’t. 9 digit routing no. (bottom left on your check – PRINT CLEARLY):__________________________________________________
Checking acc’t. 10 digit account no. (bottom middle on your check – PRINT CLEARLY):______________________________________________
Charge my checking acc’t.: $_______________ today. Charge my checking acc’t.: $_______________ on ____________ (date)
Charge my checking acc’t.: $_______________ on ____________ (date) Charge checking acc’t.: $ ______________ on ___________
(date)
Checking acc’t. owner Signature: ________________________________________________________ Date:_____________________
==========================================================================================================
Camper’s Name(s): #1______________________________________________________________________________
#2______________________________________________________________________________
#3______________________________________________________________________________
FORM #4
OPTIONAL
RETAIN A COPY FOR YOUR RECORDS