Summer Camp Membership Application

Summer Membership Application

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Parent/Guardian Information
Members
Member #1 Information




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Emergency Medical Information



Swimming Ability



Consents

Member #2 Information




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Emergency Medical Information



Swimming Ability



Consents

Member #3 Information




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Emergency Medical Information



Swimming Ability



Consents

Member #4 Information




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Emergency Medical Information



Swimming Ability



Consents

Member #5 Information




$
Emergency Medical Information



Swimming Ability



Consents

Member #6 Information




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Emergency Medical Information



Swimming Ability



Consents

Member #7 Information




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Emergency Medical Information



Swimming Ability



Consents

Member #8 Information




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Emergency Medical Information



Swimming Ability



Consents

Emergency Contacts
Parent/Guardian Acknowledgement & Consent
I hereby give consent for my child(ren) to participate in the Nantucket Boys & Girls Club 2020 Summer Program and further give my authorization to the Staff of the Nantucket Boys & Girls Club to arrange for routine or emergency medical care and treatment necessary to preserve the health of my child. I acknowledge that I am responsible for all reasonable charges in connection with care and treatment rendered and agree not to hold the Nantucket Boys & Girls or any member of their staff responsible in the unlikely event of an accident.

Volunteer Program
In order for the Club to maintain low membership fees we have a volunteer program. As a parent/guardian of a member of the Club, any time you could give throughout the year would be greatly appreciated. 

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Payment
Discounts
  • Early Bird Discount
    20% off for full summer memberships only and complete payment submitted before March 27, 2020
  • Multi-sibling Discount
    10% for both full summer and weekly memberships when registering two or more siblings together 

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Financial Aid

A 20% deposit will be due at the end of this application. 
If selected to receive a scholarship, the money will be refunded
but must be paid at this time in order to save a spot. 
Financial Aid Application
When the parent/guardian of a member is not able to pay the full amount of the annual school year membership fee this financial aid request form must be completed and submitted to the Club. Please provide documentation verifying stated income. If financial aid is granted it will be for the current school year only. Financial aid will be
based on financial need only. This form must be filled out and approved by the Executive Director.

Please follow the instructions in each of the sections listed below. Failure to follow the instructions could result in being disqualified from receiving financial aid.
Please list all dependents living in your household (other than program participants): 





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Employment Information
Income Information

Please list any additional income
(e.g. Child Support, SSI, Alimony, WIC, SNAP, Other)









Acknowledgement and Signature

Payment
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Nantucket Boys & Girls Club
Please consider adding an additional contribution to your membership payment. Your gift can change a child's life and support our island community
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