Nantucket Boys & Girls Club | Summer Camp 2021 Registration

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Nantucket Boys & Girls Club
Member Information
Nombre del Miembro
Apellido del Miembro


Origen étnico

Fecha de nacimiento
Summer campers, at the minimum, must be 5 years old by the start of Summer Camp 2021 and entering the 1st grade. 

Los campistas de verano, como mínimo, deben tener 5 años al comienzo del Campamento de verano 2021 y entrar al primer grado.
Direccion de casa
Código postal
¿Ha sido su hijo miembro del Club en el pasado?
Nombre de Escuela

Member Medical Information
Médico del niño
Número de teléfono
Compañía de seguros
Política #
Permiso para tratamiento por parte del médico/hospital

Notas o excepciones

¿Tiene su hijo alguna afección crónica de salud?

¿Tu hijo tiene alergias?
¿Su hijo lleva alguno de los siguientes?
If your child requires an inhaler, epi-pen, or medication, he/she must have access to them while at the Club. We suggest dropping of an extra for the Club medication box. 
¿Alguna información adicional que el NBGC deba conocer?
¿Le gustaría que un director se comunique con usted para hablar sobre cualquier necesidad especial que su hijo pueda tener antes del inicio del campamento?

Requerimos una copia reciente (dentro de 1 año) de los registros de vacunación de su hijo.

¿Ha recibido su hijo lecciones de natación o ha sido parte de un equipo de natación?
¿Se siente cómodo con que su hijo participe en actividades acuáticas?
Parents/Legal Guardian Information
Nombre del tutor legal
Dirección de correo electrónico
Número de teléfono
Nombre del empleador
Nombre del tutor legal
Dirección de correo electrónico
Número de Teléfono
Nombre del empleador
Emergency Contact Information/Infarmación en caso de Emergencia
Número de Teléfono
Número de Teléfono
Parent/Guardian Waiver + Acknowledgments

Parent/Guardian Acknowledgment and Consent

I hereby give consent for my child to participate in the Nantucket Boys & Girls Club 2021 Summer Program and further give my authorization to the Staff of the Nantucket Boys & Girls Club to arrange for routine or emergency medical care and treatment necessary to preserve the health of my child. I acknowledge that I am responsible for all reasonable charges in connection with care and treatment rendered and agree not to hold the Nantucket Boys & Girls or any member of their staff responsible in the unlikely event of an accident. 

Nantucket Boys & Girls Club complies with regulations of the Massachusetts Department of Public Health and is licensed by Nantucket Health Department.  Parents may request copies of background checks, health care and discipline policies, by contacting the Executive Director.

Swimming and Water Activities

A part of your child’s Nantucket Boys & Girls Club summer program experience is spending time at the beach and in the water. Our waterfront policies and procedures have been carefully designed to insure safety at all times. Staff members overseeing waterfront activities hold lifeguard certifications, have received additional training regarding specific waterfront and beach related safety procedures, and are supervised by our Aquatics Director while facilitating any water activities. Beach activities and staff performance will be closely supervised to insure compliance with all policies and procedures.


Students spend time at north shore and harbor beaches only; e.g., Dionis, Brant Point and Children’s Beach. It is important parents/guardians and your children understand all water activities are optional. If members do not wish to participate in water activities there are many other options provided.


Each member’s swimming ability will be tested the first day they participate in a beach activity. In order to help insure your child’s safety, please rate your child’s swimming experience and ability. This information will be included on your child’s emergency contact card which is carried by the staff leader on all field trips and beach trips.

COVID Assumption of Risk & Waiver Letter

Dear Parents, 

As you are certainly aware, COVID-19 is an extremely contagious communicable illness that is spread through person-to-person interactions. Not all individuals infected with COVID-19 display any symptoms, but such individuals may nonetheless be contagious and spread the infection. State and local authorities are closely monitoring the spread of COVID-19 in the Commonwealth of Massachusetts and on Nantucket, and have introduced mandatory quarantines, social distancing and other safety measures to prevent the spread of the disease. Please also note that the Club’s plans will also be subject to change based on evolving guidance and changes in federal, state and/or local mandates or guidance.

Click here for all COVID protocols and regulations that we will be following this school year.

Although NBGC will comply with all applicable safety requirements, so long as COVID-19 continues to spread by community transmission and until there is an effective vaccine, there will be a risk that members could become infected with COVID-19 despite those efforts.

  • That risk extends to the families of members as well.

  • By electing to send your child to the Nantucket Boys & Girls Club this school year, you acknowledge and agree that the safety policies and procedures outlined above are reasonable under the circumstances, and that there is nonetheless a risk that your child could contract COVID-19 and/or become a symptomatic and/or asymptomatic carrier of COVID-19 despite the above safety policies and procedures.

  • By signing below, you knowingly and voluntarily assume that risk, as well as the risk that such infection could spread to other members of your child’s household or family.

  • By signing below, you hereby agree, on your own behalf and on that of your child, and of your heirs, executors, administrators, personal representatives, and/or assigns (“Releasors”), to forever release, acquit, discharge, and covenant to hold harmless Nantucket Boys & Girls Club, its trustees, employees, volunteers, representatives, and agents (“Releasees”) from any and all claims, suits, liabilities, and actions, including, but not limited to, any negligence of Releasees, which Releasors may have, now or in the future, which relate in any way to your child contracting COVID-19, or any symptoms or complications arising from COVID-19, as a result of attending any NBGC programs.


Further, by signing below, you agree that you, your child and anyone in your immediate household will abide by applicable terms of the Club’s plans, including without limitation, a 14-day self-quarantine if you travel out of state, and/or if anyone newly arrives to reside in your household from out of state. Questions about travel out of the country or out of the state will be addressed to you throughout the summer, as part of the Club’s plans.

Finally, in these uncertain times, you understand and agree that the duties and obligations of the Club may be modified or suspended immediately and without notice because of causes beyond the Club’s control, such as threats to the health and safety of members and staff, including the Covid-19 pandemic or actions by Government officials or health officials regarding the pandemic. If such an event occurs, you acknowledge and agree that the Club is not obligated to provide any refunds of payments made to the Club.


Jamie Foster, Executive Director

Haga clic aquí para obtener una traducción al español de las exenciones de responsabilidad y exenciones: Exensión de padres/tutores y reconocimientos para Summer Camp 2021 

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Member Week Selection
Please indicate which grade your child will be this Fall, 2021 for each week your child will attend camp. This will help us with reporting. 
grado en otoño de 2021
grado en otoño de 2021

Week 3 (July 12-16) is FULL.  

Week 4 (July 19-23) is FULL. 

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grado en otoño de 2021

Week 5 (July 26-30) is FULL. 

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grado en otoño de 2021

Week 6 (August 2-6) is FULL. 

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Week 7 (August 9-13) is FULL. 

Week 8 (August 16-20) is FULL. 

Please email to be placed on our waitlist

grado en otoño de 2021
Discount Options
Click here to download our Summer 2021 Financial Aid Form. Forms may be completed and emailed to 
Refunds: will only be given in unique circumstances. 


Payment Information

Admin Only - Payment Tracking Info