Please check all that apply. Weekly fees are $395 except Week 3 which is $240 (closed July 4&5).​​​​​​
Before Care is offered from 8-9am. After Care is available from 2pm until as late as 5pm.​
Before Care (beginning at 8am) will be offered at the rate of $50/week. (Week 3 will be $30)​​​
After Care will be offered from 2pm until 3:30pm at the rate of $50/week. (Week 3 is $30)​​​​
Extended After Care will be offered from 3:30pm until 5pm at the rate of $25/week. (Week 3 is $15)​​

Parent Information

Emergency Information

Please list an emergency contact other than a parent.

Pick Up Authorization

The following people are authorized to pick up my child from camp (in addition to parents)

By submitting this form, I understand that Ridgefield Academy is a non-profit organization which makes it facilities, programs and activities available to persons only on the condition that they agree to assume complete responsibility for any injury or damage. I acknowledge that Ridgefield Academy programs and activities may involve risk, and assume those risks for my child. Further, in consideration of acceptance of my child into the Ridgefield Academy Camp and/or it’s sponsored programs and activities, I release and agree to hold harmless Ridgefield Academy, it’s officers, directors, employees and staff from any claims or damage or loss (including but not limited to physical injury, and property damage) that may occur as a result of my child’s participation in any Ridgefield Academy sponsored program or activity. I hereby give the foregoing release on behalf of myself, my child, and all family members of either of us, and confirm that I authorize to do so. I understand that Ridgefield Academy does not carry medical/accident insurance, and that I am responsible for any and all charges for medical treatment, property damage, or acquiring my own insurance. I acknowledge that participation in Ridgefield Academy sponsored activities is conditional upon compliance with all applicable rules and policies established at Ridgefield Academy. I further acknowledge that Ridgefield Academy sponsored activities and participants may be photographed, filmed or videotaped from time to time, and hereby consent use of my child’s picture and likeness for Ridgefield Academy related promotional purpose without further consideration.

Upon submission, a nonrefundable $50 registration fee will be charged to your credit card. Prior to camp, an invoice reflecting your camp fees will be sent to you and must be paid on or before June 3, 2019.