2014 DATES & CAMPER APPLICATION

 

Camper Name:
Age (at camp 2014):
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 8,9 & 10
Sunday, June 22 - Friday, July 4
2nd Session: Ages 11 & 12
Sunday, July 6 - Friday, July 18
3rd Session: Ages 13 & 14
Sunday, July 20 - Friday, August 1
4th Session: Age 15 & 16
Sunday, August 3 - Friday, August 15

All sessions are $250 and will be due in the Spring. * See note below

 
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.

Please note that in the Spring, we will send you a health history and examination form and additional cardiac history forms that must be completed and returned prior to camp.

* Please note that due to financial realities a modest fee is being charged per session. Arrangements for scholarships on an as needed basis will be made available to ensure participation for all our Madden families.*

For a copy of a MAIL IN FORM CLICK HERE

 

about us testimonials programs/facility staff application friends contact us home


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

413-528-2229