Enrollment Application and Terms
Camp Pinehurst
Summer Camp for Boys & Girls
Accepting Boys and Girls ages 6-14  

2012 CAMP SEASON                           Please Circle the Desired Weeks

{July 1-July 8} {July 8- 15} {July 15-22} {July 22-29} {July 29-August 5} {August 5- 12}

Two week sessions available only:
{July 1-July 15}     {July 15- July 29}     {July 229- August 12}

Two Week  
   Three Week    
Four Week   
Five Week    
Six Week  
  Sessions:    
   Sessions:    
 Sessions:    
  Sessions:    
  Session:    
        $2,250            
$3,025
          $4,030               
    $5,040
      $5,475  

Add Water skiing, Wake/Knee boarding @ $40/week for____ weeks   




Enroll my Son/Daughter________________________________________________________________________
                   (circle one)                                         Full Name of Applicant

Names of Parents_____________________________________________________________________

Home Address_______________________________________________________________________

City__________________________________State__________________________Zip_____________


 Date of Birth_______-________-________Previous Camp Experience__________________________
                       Month         Day          Year          

 School Attending______________________________________Grade Entering___________________

         I agree to pay the full tuition before May 1, 2012.  I understand no adjustment will be made for arriving late, leaving early or withdrawal.  Fees cover board, lodging, insurance, laundry, supervision, instruction and participation in regular activities offered at Camp Pinehurst.  Enclosed is my $300.00 non-refundable deposit.  Camp Pinehurst reserves the right to send home without tuition adjustment any camper whose behavior in the opinion of the directors is detrimental to the welfare or standards of the camp group.


Signed_________________________________________________________Date_________________
                                     Parent or Guardian

Business Address______________________________________________________________________

Business Telephone__________________________Home Telephone____________________________

Email Address:_______________________________________________

Checks should be made payable to CAMP PINEHURST
and sent with completed application to:

Mr. & Mrs. John L. Curtis JR
12 Cider Lane
Nashua, NH  03063