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Bouncing Bears Summer Camp Registration Form 2021
Campers aged 3 1/2 to 5; must be three by 01/01/2021
Camper Information
Parent Information
Custodial Parent
Custodial Parent
Choose your Camp Dates
Week One ~ June 21 to June 25 ~ Wacky Wizards
Camp Only 9 am to 1 pmWhole week or Single days
Early Care starts at 8:15 amWhole week or Single Days
Week Two ~ June 28 to July 2 ~ Star Wars
Camp Only 9 am to 1 pmWhole week or Single Day
Early Care starts at 8:15 amWhole Week Single Day
Week Three ~ July 6 to July 9 ~ Super Sports (No camp July 5)
Camp Only 9 am to 1 pmWhole week or Single Day
Early Care starts at 8:15 amWhole Week Single Day
Week Four ~ July 12 to July 16 ~ Disney Mania
Camp Only 9 am to 1 pmWhole week or Single Day
Early Care starts at 8:15 amWhole Week Single Day
Week Five ~ July 19 to July 23 ~ Ninja Warriorfest
Camp Only 9 am to 1 pmWhole week or Single Day
Early Care starts at 8:15 amWhole Week Single Day
Week Six ~ July 26 to July 30 ~ Color Wars (Three day minimum this week)
Camp Only 9 am to 1 pmWhole week or Three days
Early Care starts at 8:15 amWhole Week Single Day
Week Seven ~ August 2 to August 6 ~ Wet N Wild!
Camp Only 9 am to 1 pmWhole week or Single Day
Early Care starts at 8:15 amWhole Week Single Day
Week Eight ~ August 9 to August 13 ~ Code Name: Spy Kids
Camp Only 9 am to 1 pmWhole week or Single Day
Early Care starts at 8:15 amWhole Week Single Day
Week Nine ~ August 16 to August 20 ~ Lights, Camera, ACTION!
Camp Only 9 am to 1 pmWhole week or Single Day
Early Care starts at 8:15 amWhole Week Single Day
Week Ten ~ August 23 to August 27 ~ Summer Rewind
Camp Only 9 am to 1 pmWhole week or Single Day
Early Care starts at 8:15 amWhole Week Single Day
Tell Us About Your Child

(a) Mental- Emotional-Social-Health. (MESH)

Camp is a fast-paced, group oriented, social, hands-on learning experience that can have a tremendous positive impact on children. That said, every child needs to be ready for camp!  In order for your child to make the transition to camp as smoothly as possible and to have the most positive experience, it helps us to know about anything that might affect your child’s ability to participate fully and successfully.

 Please be candid! The reason we need this information is to prepare for your child in a way that supports their transition to and successful participation in camp.

Does your child experience challenges that affect their experiential success and/or academic success (i.e. ADHD, sensory processing/sensory integration, dyslexia, hearing or vision loss)?
Does your child experience (or been diagnosed with) challenges that affect their social, emotional, mental wellbeing (i.e. anxiety, mood or behavioral)?
Is your child challenged by/diagnosed with a specific condition (i.e. Asperger’s, Autism, Anxiety)?
Does your child take medication related to social, emotional and/or behavioral wellbeing?
Does your child have an IEP (Individualized Educational Plan) or 504 Behavioral Plan in school?
During the past year has your child received the services of a professional for motor, emotional, behavioral or mental health issues either in school or at home?

b) Medical Issues/Allergies

c) Sunscreen/First Aid

Can we apply Sunscreen to your child?
Can we apply First Aid ointments if needed to your child? *ointments refers to anti-itch cream or anti-bacterial ointment.

d) Friends Are there any friends that your child would liked to be placed with? We do everything we can to accommodate requests, but cannot guarantee same group placement.

Mesh/Health Policies PLEASE READ

Per State of New Hampshire Licensing regulations, we must have a Completed Summer Camp Medical Form on file before your child attends any summer camp. There are NO EXCEPTIONS to this policy.  Completed forms must be submitted by May 15, 2021. Please plan accordingly as this form must be completed by your child’s physician.  These forms are also available on our website.   Physical exams completed within two years of camp attendance are valid. 

For campers requiring an epi-pen, inhalers or prescription, or OTC medication we require a Medication Consent Form. This form is available on our website www.summeratbrentwoodcommons.com. We also require a FARE form if applicable.  (Food Allergy and Anaphylaxis Emergency Care Plan)

If you answer “yes” to any questions in section (a), we may call you to learn more about how best to support your child.  We may also ask you to provide additional information from the professional working with your child. 

If, in our estimation additional counselor support is necessary, additional fees may be applicable. Please review the MESH policy and information on our website and in the parent handbook

If any of your answers or information about your child changes between registration and the first day of camp, please contact a camp director as soon as possible.

Campers who leave the program due to behavioral reasons will not receive refunds for unused camp days.

I have read and agree to the above MESH/Health policies
Camp Rates and Payment Information

Full Weeks: $245 per week

July 6th Week: $196 per week

Single Days: $58 per day (5 day minimum)

AM care: $8 per day 

Payment MethodYou have payment options, please choose one.


*Payment in full option;  If you choose to call with a card or mail a check, we will email a total upon receipt of registration form.  Camp enrollment will not be secured until payment has been arranged.  

*50% payment option: 50% is due when you register and 50% will be billed to the card on file on May 15, 2021,  This option requires a credit card on file.

Payment Plan Option:  25% is due when you register.  The balance is divided into weekly payments.   The final payment must be made by July 9, 2021.  A $2.00 fee will be added to each weekly payment until balance is paid in full. This option requires a credit card on file.  Weekly payment will be charged to the card on file. Payment plans will begin February 26.

Camp registration will not be complete until payment/deposit has been received. Registrations received after MAY 15 must be paid in full or enrolled in the payment plan option.

General Summer Camp Administrative Policies

Our summer camp refund policy:

  • Any date changes to your original camp registration can be made until May 15, 2021 Space permitting  All requests must be made in writing.
  • Minimum registration requirements: 5 days​ Color Wars/Week Six: 3 day minimum
  • Make ups for missed camp days are not available.
  • Full refunds will be available if Covid related restrictions prevent us from operating during the 2021 summer camp season.
  • Full refunds less a $50 admin fee, will be available until 04/01/2021 should you choose to withdraw due to Covid-19 related reasons.  
  • We offer house credit for cancelled summer camp weeks, from 04/02/2021 to 05/15/2021. No refunds
  • No house credit or refund for any cancelled camp registration after May 15, 2021.
  • The completed registration form must be received to reserve camp days.  We regret we cannot take reservations over the phone. 


I, the duly authorized parent or guardian of the above-named Minor “Participant”, understand that the individual and/or group gymnastics and other physical exercise sessions, programs or activities conducted at Action Kids at Brentwood Commons, Inc. (hereafter “Action Kids”) may involve gymnastics, tumbling, fitness, trampoline, cheerleading, dance, ball sports, swimming and martial arts, as well as the use of exercise equipment, amenities and facilities owned and/or operated by Action Kids, its representatives or its contractors (collectively, the “Activities”).

I,  as the parent/guardian of the below-named Minor Participant, as a condition of authorizing their participation in such Activities do hereby agree to RELEASE and DEFEND, HOLD HARMLESS, and INDEMNIFY Action Kids, its shareholders, directors, officers, agents, faculty, volunteers, employees, representatives and contractors (hereinafter “the Releasees”) from all liability, claims, expenses, fees, fines, penalties, losses, suits, proceedings, actions and costs including attorneys’ fees and court costs, including personal injury and death, resulting from or arising out of their participation in the Activities whether caused by the alleged NEGLIGENCE of the Releasees or otherwise.

I understand that the Activities in which my child or ward will be engaged may be dangerous, and I, as their parent or guardian, voluntarily choose to assume those dangers. I also recognize that by participating in the Activities my child or ward may experience injuries including, but not limited to, death or disability, and I willfully ASSUME THOSE RISKS. I agree that THIS LIABILITY RELEASE AGREEMENT IS BINDING ON THE PARTICIPANT AND THEIR PARENTS OR LEGAL GUARDIANS, PERSONAL REPRESENTATIVES, HEIRS, AND ASSIGNS.

In the event of accident or emergency, I hereby authorize Action Kids to transport the Participant, or cause the Participant to be transported, to a medical facility for medical treatment and I agree to release, indemnify, defend and hold Action Kids and its representatives harmless with regard to same. I hereby agree to be fully and solely responsible for all medical expenses which may be incurred as a result of the Participant’s participation in the Activities.

I understand that my child or ward’s participation in the Activities at Action Kids may be photographed, video recorded, audio recorded, or otherwise recorded. I acknowledge that Action Kids retains the right to use such photographs, video or audio recordings or any other recording of events for publicity, advertisement or any other legitimate purpose and I hereby consent to such use.

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