glen urquhart school summer program

june 28-august 6, 2010

registration form
child’s name sex m f dob
nickname entering grade in fall 2010
address school
zip how did you learn about gus summer program?
home phone

parent’s name parent’s name

address address
zip zip
home phone home phone
work phone work phone
cell phone cell phone
email email

child’s t-shirt size, if registered by june 8th (circle one) child s m l adult s m l
friend request: please try to place my child with
my child will be a new student at gus in the fall of 2010 yes no

this waiver must be signed to complete registration.

• i agree to fully complete medical and emergency forms and have them delivered to gus summer program by june 8, 2010.
• i understand that my child may not attend the program until fully completed medical and emergency forms, a condition
of camp attendance per the massachusetts board of health, are delivered to gus. refunds will not be given for days missed
due to lack of properly completed forms.
• i agree to pay the balance of my child’s tuition on or before june 8, 2010.
• i give permission to the gus summer program to take, use, publish and reproduce photographs, slides, or videos of my child
for its records or publications.
• i grant permission for my child to participate in all planned gus summer program activities, including trips to the beach
and/or off-campus facilities, bus or van trips, field trips, and nature walks, understanding that competent leadership and
supervision will be provided.
• i understand that the tuition is non-refundable for withdrawal, dismissal, failure to attend, or incomplete attendance.
to receive a tuition refund, cancellations must be made 30 days prior to the start of the workshop.
• i understand that workshops that do not meet the minimum enrollment may be canceled.

parent/guardian signature date

Please complete this form, along with the selection form on the reverse side, send completed registration forms to:
for each child whom you are registering for GUS Summer Program. Half of debora diggins
the total cost of tuition is due with registration. The remainder of tuition is director of summer program and after-school care
due by June 8, 2010. Please contact the Director for more information. glen urquhart school
74 hart street, beverly farms, ma 01915
978 927-1064 ext. 131 fax 978 921-0060
ddiggins@gus.org
registration form glen urquhart school summer program
❏ please check the boxes to make your choices. june 28 – august 6, 2010
week 1 week 2 week 3 week 4 week 5 week 6
june 28–july 2 july 5–july 9 july 12–july 16 july 19–july 23 july 26–july 30 august 2–august 6
ages 4–5 pioneers
session 1 the wild west | $325 ❏ session 2 art adventures | $325 ❏ session 3 the science of cooking | $325 ❏
session 1 the wild west | $495 ❏ session 2 art adventures | $495 ❏ session 3 the science of cooking | $495 ❏
ages 6–8 voyagers
session 1 make your own | $495 ❏ session 2 wearable art | $495 ❏ session 3 from trash to treasure | $495 ❏
ages 6–8 voyagers specialty workshops
can you dig this | $225 ❏ basic dance | $225 ❏ young naturalists | $225 ❏ fun in the garden | $225 ❏ oobleck and other weird designing, naturally
science experiments | $225 | $225 ❏
junkyard lego robotics hip hop dance | $225 ❏ kids in the kitchen with
american girl doll | $225 | $225 ❏ angela | $225 ❏ art sampler | $225 ❏ game time! | $225 ❏
ages 9–12 explorers
adventures in the garden | $395 ❏ fashion and fabric design workshop | $395 ❏
graphic novel book club digital painting | $225 ❏
| $225 ❏
creating and performing an original script | $395 ❏
angela’s kitchen | $225 ❏ hip hop dance | $225 ❏ chocolate factory | $225 ❏
math busters | $225 ❏ beginning digital photography,
experimental drawing and iphoto, and photoshop fantastic fibers | $225 ❏
painting | $225 ❏ art sampler | $395 | $225 ❏
❏
environmental science | $225 ❏
outdoor living skills
filmmaking (choose either session a or session b) $395 | $225 ❏
session a 9:00 am-12:00 pm | ❏ • session b 1:00 pm-4:00 pm | ❏
south american cuisine
WE HAVE REDUCED OUR FEES FOR SUMMER 2010 | $225 ❏
ages 4–8 afternoon activities

afternoon activities The Afternoon Activities program offers play and adventure for ages 4-8. Any child, regardless of being registered for a morning workshop, may enroll in this program. | $95 ❏
ages 9–12 afternoon adventures

afternoon adventures The Afternoon Adventures program offers play and adventure for ages 9-12. Any child, regardless of being registered for a morning workshop, may enroll in this program. | $95 ❏
ages 13-14 teen apprentice program (tap)
per two-week
teen apprentice program The Teen Apprentice Program (TAP) was started in 1997 to give teens the opportunity to prepare for future employment as camp counselors, teachers, and other professionals who work with children. | $275 ❏ session

send completed registration forms to: debora diggins

director of summer program and after-school care gus summer program tuition total:
glen urquhart school
74 hart street, beverly farms, ma 01915
978 927-1064 ext. 131 fax 978 921-0060
ddiggins@gus.org