2012 Camper/CIT New Application

Camper/CIT Information
NOTE: All entries with * are required. Others are optional but please enter as much as you can.
   
*English Last Name:
*English First Name:
Chinese Last Name:
Chinese First Name:
*Gender:
Male
Female
*School Grade (number only, in Fall semester):
*Birthday (format yyyy-mm-dd; e.g., 1991-01-31):
*Program:
Day (6-10 yrs) $390
Overnight (10-14 yrs) $695
ExplorAsian (9-12th grade) $710
CIT (11-12th grade) $395
Counselor
Camper Phone (format xxx-xxx-xxxx):
Camper Email (format xxx@xxx.xxx):
 
*Camper T-Shirt Size:
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult Extra Large
*Address - Street (100 characters max):
*Address - City/Town:
*Address - State (e.g., MA):
*Address - 5-digit Zip Code (e.g., 01719):
 
Parent/Guardian Information
NOTE: Please enter as much contact information as possible in case we need to contact you for application or during the camp week.
 
*Main Contact Last Name:
*Main Contact First Name:
Main contact Chinese Last Name:
Main contact Chinese First Name:
*Main Contact Relationship:
Father
Mother
Guardian
*Main Contact Home Phone (format xxx-xxx-xxxx):
Main Contact Work Phone (format xxx-xxx-xxxx):
Main Contact Cell Phone (format xxx-xxx-xxxx):
*Main Contact Email (format xxx@xxx.xxx):
 
Secondary Contact Last Name:
Secondary Contact First Name:
Secondary Contact Chinese Last Name:
Secondary Contact Chinese First Name:
Secondary Contact Relationship:
Father
Mother
Guardian
Secondary Contact Home Phone (format xxx-xxx-xxxx):
Secondary Contact Work Phone (format xxx-xxx-xxxx):
Secondary Contact Cell Phone (format xxx-xxx-xxxx):
Secondary Contact Email (format xxx@xxx.xxx):
 
Parent On Duty (POD) Preference
NOTE: One shift required for Overnight and ExplorAsian program. If you can not serve POD, please select Paid Waiver. For all other program we encourage parents to help out.
 

*POD Preference

OVERNIGHT/ExplorAsian Program (required)
Parent #1 as POD
Parent #2 as POD
Paid Waiver ($200 fee)
 
Day/CIT Program (optional)
Parent #1 wants to help
Parent #2 wants to help
 
I am willing to be a POD lead
 
   
Roommate, Group, and Special Requests
NOTE: If no roommate name is indicated, a roommate of the same sex and age category will be assigned. We recommend that campers do not request group assignments with friends so they have the opportunity to make new friends.Only campers request each other will be considered. Ask your friend to put your name as their preference.
 
Roommate Name or Room Request:
Group and Special Request:
 
Supplemental Information
Note: Required for CIT and optional for ExplorAsian, send application by email. Please follow the instruction to complete it by application deadline when applicable.
*ExplorAsian Supplemental Information is optional

Supplements for the ExplorAsian application can be found on the website www.necysc.org/download.html .

One of ExplorAsian's main goals is to develop leadership skills.  Please respond in an essay to one of the questions below:

  1. What does being a leader mean to you?
  2. Describe a leader in your community whom you look up to. 
  3. Tell us why you are a good candidate for ExplorAsian.
Feel free to also comment on the class topics and activities you would like to see.  Be creative.  Your responses could very well shape the curriculum.  Send your essay to explorasian@necysc.org  with the subject '[Your Name] Application Essay' before application deadline
 
*CIT Supplemental Information (deadline February 15th)

Supplements for the CIT application can be found on the website www.necysc.org/download.html .  Please note that there are two different applications for CIT applicants. The "New CIT Application" applies to all applicants who have never been a NECYSC CIT before. The "Returning CIT Application" applies to all applicants who have been a NECYSC CIT in the past.
 
Application/Payment Information

*Camp Fee:
Parent On Duty (POD) Substiute Fee:
Voluntary Donation (tax deductible receipt will be mailed after camp):
TOTAL:
 

I would like to receive a tax receipt after the camp.

I am also applying for financial aid. I will submit 50% of my payment to hold my application. Please download and submit the financial aid application form from http://www.necysc.org/financial_aid/ for consideration. Use original amount for the Camp Fee field and 50% amount for the TOTAL field.

I do not wish my name to be listed with my donation
 
Additional Information
Check if you want us to contact you to place ads in Camp Book

Check if you don't want to publish name/address/phone in camp week-book

Check if you want to publish name/city/phone in day camp car pool list
 You like to be contacted via method below:
     postal mail
     electronic mail
     no preference
 
By clicking the Submit button below I certify that I have read and understand 2012 NECYSC Camp Information and the information provided on this application form is accurate to the best of my knowledge.
NOTE: After you submit this application please make sure you see a confirmation page. You need to mail your check with confirmation number and camper's name to NECYSC, 11 Sherburn Circle, Weston, MA 02493 to complete the application as soon as possible. The application priority is based on the postmark date of the check you will mail. Print a copy of this form and the confirmation page for your own record. Contact registration@necysc.org if you have trouble to complete online application.