DUNNABECK
at Kildonan
Morse
HillRoad
Road
425425
Morse
Hill
Amenia,
New
York
Amenia, NY 1250112501
Phone:
(845) 373-8111
373-8111
Phone:
(845)
Fax:
(845)
373-2004
Fax: (845)
373-2004
Web:
www.kildonan.org
Email: admissions@kildonan.org
e-mail:Web:
admissions@kildonan.org
www.kildonan.org
ApplicAtion for Admission
Camp Dunnabeck
Application for Admission
Applicant's name _______________________________________________________________
Home Address _________________________________________________________________
______________________________________________________________________________
telephone ______________________________
date of Birth ________________
Age________
is the applicant adopted? ________
if yes, when? ___________________
country of citizenship ____________________
Applying for:
social security no. __________________
m
Boarding APPLICATION
full-day
CHECKLIST:
f
Half-day
1
Completed Camp Dunnabeck Application
name and address of present
_______________________________________________
1 school:
Review
viewbook and admission materials
1
Forward copies of the most recent educational and ______________________________________________________________________________
psychological testing. The Weschler Intelligence Test with subtest scores is required for all applicants.
student is currently enrolled
in
__________
willphotograph
be entering __________
grade next year.
1 Include agrade;
recent
of the applicant.
1
$30.00 application fee (non-refundable).
Grades repeated (if any) __________________________________________________________
If you have any questions about the admissions process or the
application forms, please contact the Admissions Office at
(845) 373-2012.
Who referred you to dunnabeck? __________________________________________________
Dunnabeck at Kildonan admits students of any race, gender,
Has student attended dunnabeck before? __________ if so, when? _____________________
creed, and national or ethnic origin to all the rights, privileges
activities
generally accorded or made available to stusummer camps previouslyand
attended:
_______________________________________________
dents at Dunnabeck.
STUDENT INFORMATION
Applying for: 1 Boarding
1 Male
Date of Birth: 1 Full Day 1 Half Day
1 Female _____________________________ Social Security #: _____________________________
Please attach a current photo
Applicant’s Name: _______________________________________________________________________
HomeAddress: (FIRST)
(MIDDLE)
(LAST)
________________________________________________________________________
(STREET AND NUMBER)
________________________________________________________________________
(CITY)
Telephone:
________________________________________________________________________
Is the applicant adopted?
(STATE)
1 Yes 1 No (COUNTRY)
(ZIP CODE)
If yes, when? ____________________________
Is there a family history of dyslexia in the family? 1 Yes 1 No If yes, please describe: ___________________________________________________________________
Does the applicant have any allergies? 1 Yes 1 No Have an EpiPen®? 1 Yes 1 No
If yes, please describe: ___________________________________________________________________
Name and address of present school: _____________________________________________________
__________________________________________________________________________________________
Student is currently enrolled in _______ grade; will be entering _______ grade next year.
Grades repeated (if any): _________________________________________________________
How did you hear about Camp Dunnabeck? _____________________________________________
Has student attended Dunnabeck before?
1 Yes 1 No If so, when? ____________
Summer camps previously attended: _____________________________________________________
FAMILY INFORMATION
Parent/Guardian: ________________________________________________________________________
(FIRST)
(LAST)
Address:
________________________________________________________________________
(STREET AND NUMBER)
________________________________________________________________________
(CITY)
(STATE)
(COUNTRY)
(ZIP CODE)
Home Phone:____________________________ Cell Phone: ______________________________
Work Phone:____________________________ Fax Number: _____________________________
E-mail:
__________________________________________________________________
Occupation:
__________________________________________________________________
Parent/Guardian: ________________________________________________________________________
(FIRST)
(LAST)
Address:
________________________________________________________________________
(STREET AND NUMBER)
________________________________________________________________________
(CITY)
(STATE)
(COUNTRY)
(ZIP CODE)
Home Phone:____________________________ Cell Phone: ______________________________
E-mail:
__________________________________________________________________
Occupation:
__________________________________________________________________
Work Phone:____________________________ Fax Number: _____________________________
Parents are:
❑ together ❑ separated ❑ divorced
If parents are not together, applicant lives with: ______________________________________
Names of siblings (if applicable) ______________________________________ Age ______ Present school or occupation
____________________________________
______________________________________ ______ ____________________________________
______________________________________ ______ ____________________________________
1. Description of student’s difficulty with academics or language skills (e.g., reading, spelling):
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
2. Description of your son or daughter including interests, likes and dislikes, ability to get along
with peers and with adults, and any other information that would be helpful:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
3. Additional information that should be available to those working with your son or daughter
(names of involved professionals, medications, hospitalizations):
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
4. Name, address, and telephone number of relative or friend who can be reached in an emergency:
__________________________________________________________________________________________
__________________________________________________________________________________________
CAMP DUNNABECK RESERVES THE RIGHT TO WITHDRAW A STUDENT’S
ACCEPTANCE OR TERMINATE PLACEMENT, IF INFORMATION PERTINENT TO YOUR
CHILD’S APPLICATION HAS BEEN EITHER INTENTIONALLY OR INADVERTENTLY WITHHELD.
Parent/Guardian Signature: _____________________________________________________________
Parent/Guardian Signature: _____________________________________________________________
Date: ________________________