2015 DATES, CAMPER APPLICATION & COST

 

Camper Name:
Age (at camp 2015):
Address:
Date of Birth:
Gender:
Female Male
# of years previously at M.O.H.C.
Name of Parent or Guardian:
Parent Email:
Parent Address:
Phone: home work cell
 

Please indicate according to AGE the camp session
in which you wish to enroll your child.

1st Session: Ages 11 & 12
Sunday, June 21 - Friday, July 3/span>
2nd Session: Ages 13 & 14
Sunday, July 5 - Friday, July 17
3rd Session: Ages 15 & 16
Sunday, July 19 - Friday, July 31
4th Session: Ages 8, 9 & 10
Sunday, August 2 - Friday, August 14
 
Cardiologist Name:
Phone:
Email:
Address:
Please give a brief summary of child's present health:
 
Yes, I authorize the use of photographs/video of my child while at camp
for promotional purposes only.
 
 

 

Completing the above form will send your application information by e-mail to the Madden Open Hearts Camp.

You will be contacted by email as soon as your application has been received.

For a copy of a MAIL IN FORM CLICK HERE

 

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The Edward J. Madden Open Hearts Camp
250 Monument Valley Road, Great Barrington, Massachusetts 01230

413-528-2229