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2021 Covid 19 Summer Camp
Application
SESSION 5 is full
We are ready to go and we can’t wait to welcome campers back for Summer 2021! Last summer we were one of the few Newton camps to open. This is because we know that in-person activity is so crucial to child development and that parents need to know that their kids are safe and well cared for throughout the work day. Throughout the pandemic, the John M. Barry Boys & Girls Club has been steady, reliable, and safe. Let us be there for you in 2021.This summer we're featuring an endless supply of age-appropriate activities that include Fine Arts, Coding, and Animation - activities that will capture the camper’s imaginations and while they learn new skills with each 2 week session.
Outdoor opportunities such as Archery and Athletics and STEM Activities like Solar Energy Robots will help your camper build friendships and broaden horizons in a safe, healthy, and positive environment. The rules are still taking shape for Summer 2021, but we remain hopeful that field trips and outdoor swimming will be back and that group sizes may safely expand. Regardless of the format, we will work hard to make sure your child gains a summer full of life long memories.
As we have since the start of the pandemic, we will follow Covid-19 protocols and take the necessary steps to help keep our campers and their families safe. From masks, to small groups, to pre-arrival surveys, to temperature checks we will continue to meet or exceed CDC guidelines and health department requirements to keep our campers safe. It’s time to come and enjoy the fun!
Please Note:
This form is designed to collect your campers basic needs for the 2021 summer camp season. To complete your registration you must switch over to our IMIS member system to update your account or sign up for your free account if this is your 1st time participating at The John M Barry Boys & Girls Club of Newton. As well a non-refundable registration fee of $50 is required to process your application.
Want to learn about our Policies? At any time, you may send an email to camp@newtonbgc.com and we will respond by sending you a pdf of the following policies of our camp: background check policy, disciplinary policy, grievance policy, and healthcare policy.
Campers Name
Gender
Male
Female
Other
Male
DOB
Age
5
6
7
8
9
10
11
12
13
5
Grade
K
1
2
3
4
5
6
7
8
9
K
School
Angier
Bowen
Burr
Cabot
Countryside
Franklin
Horace Mann
Lincoln-Eliot
Mason-Rice
Memorial Spaulding
Peirce
Underwood
Ward
Williams
Zervas
Bigelow
Brown
F.A. Day
Oak Hill
Newton Central
Newton North
Newton South
OTHER
Angier
Is this your first time at Camp BGC?
Yes
No
Yes
Choose your camp
Camp Spark (Grades K-1)
Camp BGC 1 (Grades 2 & 3)
Camp BGC 2 FULL No spots available
Camp BGC 3 (Grades 6 - 8)
Camp Spark (Grades K-1)
Camp 2021
We apologize for the inconvenience however, all of our sessions are at capacity. We look forward to seeing you next year.
Non-refundable registration fee
Camp Full
We will operate extended care from 8AM to 5PM, for an addition fee of $100 per session
Will your child
need Extended Day
Morning Only
Both Morning & Afternoon
Afternoon Only
My child does not need extended day
My child HAS permission to walk home unsupervised.
Yes
No
Yes
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2021 Covid 19 Summer Camp
Application
SESSION 5 is full
Parent/Guardian
Address (1)
Cell (1)
Email (1)
Total number of people in your household.
Total Household Income
0 - $13,000
$13,001 - $17,000
$17,001 - $23,000
$23,001 - $27,000
$27,001 - $33,000
$33,001 - $37,000
$37,001 - $43,000
$43,001 - $46,000
$46,001 - $49,000
$49,001 - $53,000
$53,001 - $56,000
$56,001 - $59,000
$59,001 - $63,000
$63,001 - $66,000
$66,001 - $69,000
$69,001 - $73,000
$73,001 - $76,000
$76,001 - $79,000
$79,001 - $83,000
$83,001 - $86,000
$86,001 - $89,000
$89,001 - $96,000
$96,001 - $103,000
$103,001 - $113,000
$113,001 - $123,000
Other
0 - $13,000
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2021 Covid 19 Summer Camp
Application
SESSION 5 is full
Health Authorization:
This health history is correct so far as I know, and the person herein described has permission to engage in all camp activities except as noted.
I Agree
P
hoto Release:
I authorize The John M. Barry Boys & Girls Club of Newton, to use our child’s photo in camp brochures, videos, on websites or other promotional literature for general marketing or publicity purposes.
Yes
No
Transportation:
Should Covid-19 regulations allow it, I authorize The John M. Barry Boys & Girls Club of Newton permission for our child to be transported to and from all camp activities.
I Agree
Authorization for Treatment:
In case of a medical emergency, I authorize The John M. Barry Boys and Girls Club of Newton to administer first aid and, if necessary, transport my child to Newton Wellesley Hospital or the nearest emergency room.
If I cannot be reached in an emergency, I hereby give permission to the physician selected by the camp director, or his/her designee, to secure and administer treatment, including hospitalization, for the person named above.
I Agree
If Covid-19 Regulations allow swimming,
“Christian’s Law Regulations”105 CMR 432.000
require that Summer Camps accommodate any parent who would like to send their child to camp with a Coast Guard Approved flotation device. Please check the box at right if you intend to send one with your child:
Yes
I give my child permission to use hand sanitizer provided by The John M. Barry Boys & Girls Club of Newton.
Yes
I understand that all sales are final as of June 3rd and that I may not have the opportunity to change my reservation later due to exepected Covid-19 capacity limitations
I Agree
Risk & Waiver:
We, the undersigned parent, or guardian(s) of the minor child whose name appears on this application, do hereby consent to his/her participation in, the John M. Barry Boys & Girls Club of Newton (henceforth the Club) Summer Day Camp Program. I/We forever RELEASE, acquit, discharge and covenant to hold harmless the Club, its successors, departments, officers, employees, servants and agent, of and from any and all actions, caused of action, claims, demands, damages, cost, loss of services, expenses and compensation on account of, or in any way growing out of, directly or indirectly, all known and unknown personal injuries or property damages which I/We may now or hereafter have as the parent(s) of or guardian(s) of said minor, and also all claims or rights of actions or damages which said minor has or hereafter may acquire, either before or after his/her participation in the Club’s programs. FURTHERMORE, I/We hereby agree to protect the Club, and its successors, departments, officers, employees, servants and agents against any and all claims for damages, compensation or otherwise on the part of said minor growing out of, or resulting from, injury to said minor in connection with his/her participation in the John M. Barry Boys & Girls Club of Newton’s Programs and to INDEMNIFY, reimburse or make good to the Club or its successors, departments, officers, employees, servants and agents any loss or damage or cost, including attorney’s fees, the Club or its representatives may have to pay if any litigation arises from said minor’s participation in the Club’s programs.
I Agree
PLEASE NOTE No registration will be complete without the application fee.
Date
MM
/
DD
/
YYYY
Payment Method
PayPal
PayPal
Accepted cards
Submit & Pay
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