The Fishing Academy

617-782-2614

16 Adair Road, Brighton, MA 02135

2010 Camp Registration

Remember to register early!
The Best Weeks Book Up Fast!

Week One: June 28th-July 2nd

Week Two: July 5th-July 9th

Week Three July 19th- July 23rd

Week Four: August 2nd- August 6th

Week Five: August 9th- August 13th

Week Six: August 23rd-August 27th

CAMP DROP OFF AND PICK UP TO BE ANNOUNCED

Please note: 2010 registration fee is $250.00 per camper
Reduced fees are on a sliding scale, based on income.

Due to the popularity of The Fishing Academy Program, all campers will be limited to one week of camp this year! Campers may be put on a waiting list for additional weeks if space is available.

Child's Name:__________________________________________________________________________________

Address:______________________________________________________________________________________

Age:__________________________________________________________________________________________

Phone #:______________________________________________________________________________________

I, (parent or Legal Guardian)______________________________________________________________________

I, (parent or Legal Guardian Email)______________________________________________________________________

Give permission for (Child's Name)__ __________________________to attend.

The Fishing Academy Summer program from 9:00AM to 3:30 PM ____________ through __________. I also give permission for my child to participate in the following activities with The Fishing Academy. Daily Trips to local Fishing spots: Charles River, Jamaica Pond, Muddy River, Brookline Reservoir, Farm Pond, Chandler Pond, Walden Pond, Crystal Lake, Castle Island, Buckmaster Pond Parental Approval Yes ______(Check Box)
Fishing Academy Trip to Sandwich Fish Hatchery Sandwich, MA. ___________
Parental Approval Yes ______.(Check Box)

I understand that my son/daughter will be obliged to abide by The Fishing Academy rules while participating in the program. In the event of serious illness or injury to my child/ward, I expressly consent to the administration of emergency medical care, if in the opinion of attending medical personnel, such action is advisable. If needed, I hereby authorize dispensation of medication by trained, non-nursing personnel in an emergency and or/life threatening situation or as prescribed by my child's primary provider.

My Child Does require medication during this authorized trip ______.(Check Box)

My Child Does Not require medication during this authorized trip ______.(Check Box)

I have read this permission slip and understand its terms. I sign it voluntarily and with full knowledge of its significance. .
Parent/Guardian Signature ______________________________________________________________________.
Child's Health Plan/Primary Care #________________________________________________________________.
Emergency Contact Name and Number ____________________________________________________________.

Click here for printable version