Application Form Ymca Day Camp - 2017
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1
2APPLICATION FORM
YMCA DAY CAMP 2017
CAMPER INFORMATION
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Name:
Birthday (day/month/year):
Age at camp:
Gender:
Male
Female
Address:
City:
Postal Code:
Home Phone Number:
Camper’s Swim Level:
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Non-Swimmer
Beginner
Average
Above Average
PARENT 1/PRIMARY CONTACT
PARENT 2/SECONDARY CONTACT
Name:
Name:
Work Phone:
Cell Phone:
Work Phone:
Cell Phone:
Email:
Email:
CUSTODY OF CAMPER
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Please Specify:
Mother Only
Father Only
Both
Other:
WHO IS AUTHORIZED TO PICK UP YOUR CHILD? (LIST ANY POSSIBLE PEOPLE TO PICK UP IN ADDITION TO PARENT 1 & 2)
Name: (other than parent)
Preferred contact number:
Name: (other than parent)
Preferred contact number:
CAMP PROGRAMS: Rovers (4-5 years old) Explorers (6-8 years old) Mavericks (9-12 years old)
Fee per week: $135 Member/$158 Non-Member Short Week Fees: $108 Member/ $127 Non-Member *Extended Care is complimentary for members
CAMP SELECTION
* All Camps CLOSED on Monday, July 3 and Monday, August 7, 2017. Short week fees apply.
WK DATES
CAMP SITE
CAMP PROGRAM NAME
CAMP FEE
OFFICE USE ONLY
EXTENDED CARE ($35)
TOTAL
Complimentary For
BARCODE
YMCA Members
1 July 4 - 7*
2 July 10 - 14
3 July 17 - 21
4 July 24 - 28
5 July 31 - August 4
6 August 8 - 11*
7 August 14 - 18
8 August 21 - 25
9 August 28 - Sept 1
One YMCA Day Camp t-shirt is included in your registration.
YMCA Strong Kids
Donation
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TSHIRT SIZE:
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S
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TOTAL
All registrations are due by noon on the Thursday prior to the camp session. Please complete one form per camper. Additional forms can be
photocopied. Incomplete forms will result in a delay of your child’s camp registration. First come first served, space is limited.
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