NAP- Neighborhood Alliance of Pawtucket

Luethi-Peterson Camps International

International Summer Camps

Application form (year of the camp)      

This application must be filled out by parents or guardian (please type
or print clearly).

Child’s   Name: first				last
Nationality:
Date of birth:	Day		Month		Year	Gender:
Full home address: (please include   city, country and postal code)
Phone number   (including country code):		Parents' Mobile Phone:

NOTE: We prefer
to send newsletters, program updates, invoice statements and personal
communications to families by email.

Preferred email address for communications throughout
the year:

Mother’s Email:
Father’s Email
Camper’s Email:

 

Mother’s name   & nationality:	Mother’s   occupation:
Father’s name   & nationality:	Father’s   occupation:
Any other   children? Give name, age and sex:

Are both parents
living?      

Child lives with:  mother    father                other:      

 

School holiday   dates	From:	To:
Is an extension   possible?	At the beginning?	At the end?

 

What languages does the applicant speak, and how   well?

Previous experience
in LPC:

Year
Location
Director
From whom did you hear about   LPC? (give full name)

 

In keeping with the goal of
promoting an inclusive society in which people are valued for their human
worth, LPC does not discriminate on any grounds, including: race, color,
religion, age, economic background, national or ethnic origin, gender,
disability, or sexual orientation.

 

 

 

 

 

 

Other group experiences (clubs, scouts, camps,
choir, etc.):

 
 

         

     

 

What has his/her travelling experience been?  Give dates:

     

What musical instrument does s/he play?

     

What do you think are the applicant’s special interests?

     

 

Special skills?

     

 

Special needs? 
(Physical and psychological) Allergies?
Attach extra sheet if necessary – We try to accommodate special needs to the
best of our ability, but it is important that we know of them in advance.

 

         

Please     attach a recent photo

     

 

 

Special characteristics? (Adaptability, emotional
stability, etc.)

     

 

Does the applicant have any
positive or negative attitudes towards specific people or groups (such as race,
religious groups, homosexuals)?

     

 

LPC camps are generally held in Europe
and North America. If you would prefer your
child NOT to go to camp in a certain country, please indicate which country and
give the reason.

 
 

         

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Finances:

 

Please indicate which tuition you can pay. The deposit must only be paid
if your child is invited to participate in a camp.

We ask you to remember that LPC campers live in countries with very
different salaries, costs of living etc. and to understand that if many
families ask to pay a reduced rate we might need to ask you in January if you
can pay more.

The tuitions are as follows:
(Please check one.) The dollar tuition is set with the January exchange rate.

  Sponsor
tuition: 235 Euro deposit plus 290 Euro per week of camp. 

  Normal
tuition: 235 Euro deposit plus 235 Euro per week of camp. 

  Reduced
tuition: 235 Euro deposit plus 180 Euro per week of camp. 

  Financial
Assistance: Please indicate how much you would be able to pay and explain the
circumstances. 

• 
  Deposit should be paid upon your child’s invitation to
  camp (February 1 deadline.)
• 
  Travelling expenses must be paid by the parents and
  are not included in the above camp cost.
• 
  Your child’s participation in an LPC camp is
  contingent upon receipt of all mandatory forms, which include, signed medical
  form, travel form and Insurance form. 
  These will be sent to you after your child’s acceptance in a camp.
• 
  I give permission to LPC to use photos and video of my
  child and to use his/her creative writing in promotional, documentary, and
  other related publications.
• 
  This application
  form must be accompanied by an independently written letter from the applicant
  explaining why s/he is interested in attending a camp with these specific
  goals.
• 
  New campers should
  also send:

1. A letter from the applicant’s school teacher
describing school work and social stability.

        2. A letter of reference
from some other group leader (scouts, etc.) or another adult who knows the
applicant well (not a relative)

I understand that my child is
expected to participate for the entire camp session.

Date:

Signature