Summer Expedition Application

Participant's Information

(Participant Only) in the space below, please tell us why you would like to be a part of the programs you've signed up for?

Parent/Guardian Information

Emergency Contact (primary and alternate)

Medical Information

Please tell us about any medical issues we should be aware of.

Please list the participant's allergies if any.

Does the participant take any medications or history of substance abuse? If so, please list.

I give permission to Lake Champlain Maritime Museum staff and representatives to dispense over the counter medication (such as ibuprofen, aspirin, acetaminophen, antihistamines, Imodium and antacids) on an as needed basis?

Does the participant have any special needs or learning disabilities that we should know about? This does not necessarily prevent participation.

Upon acceptance into the program we require a physician complete a physical then complete can sign a medical form.

Financial Aid

After you submit this form, We will contact you within 36 hours (excluding weekends) to complete the application process. Please be sure to check the box if you'd like to be considered for financial aid!