USS SALEM SUMMER ADVENTURE ONLINE FORM

UNITED STATES NAVAL SHIPBUILDING MUSEUM
QUINCY, MASSACHUSETTS

 

 

 

Fee for overnight program is $250, which includes breakfast-lunch-dinner daily, berthing and activity fees. Fee for day program is $209, which includes lunch and activity fees. Day program drop off is at 8 am with pickup at 5:30 pm.

 

 

Participant Name:

Preferred First Name:

Address:

Gender: -Male- -Female-

City/State:

Zip Code:

Email:

Home Phone:

School:

Current Grade:

Birth date: _____ / _____ / ______

Age During Adventure Week:

Mothers Name:

Work Phone:

Cell Phone:

Home Phone:

Fathers Name:

Work Phone:

Cell Phone:

Home Phone:

 

Health concerns:

 

Known Allergies: ________________________________________________________

Health Concerns: ________________________________________________________

Physical Impairments: ____________________________________________________

Current Medications: ____________________________________________________

Date of Last Tetanus Booster: _____ / _____ / _____

 

 

Preferred session:

 

Please select a first and second choice by writing a 1 or 2 in the boxes below. Each session is broken into groups based on age:

 

July 29 August 3
August 5 August 10

Mail complete registration to

 

USS Salem Summer
Adventure

United States Naval
Shipbuilding Museum

 

739 Washington Street

Quincy, MA 02169