Ymca Of Montclair - Camp Registration Form

YMCA OF MONTCLAIR

2017 CAMP REGISTRATION FORM

DOB

AGE

CAMPER’S NAME

CAMP NAME

CODE

CAMP NAME

CODE

ACE

GAP

A.C.E. - Academic Camp Experience

G.A.P. - Gaining Academics Program

CATL

Camp at the Lake Traditional

New Discoveries

ART

QUE

Camp at the Lake Arts Specialty

Summer Quest

MSPA

Camp at the Lake Outdoor Education Specialty

Summer Sparks Morning*

SPORT

Camp at the Lake Sports Specialty

ASPA

Summer Sparks Afternoon*

Early Adventures Half Day

FSPA

Summer Sparks Full Day*

EAF

Early Adventures Full Day

YBA

Y.B.A. - Youth Basketball All-Stars

EAS

Early Adventures Afternoon Specialty Camp

VOY

Voyagers

Explorers

*additional form required to select Summer Sparks classes

PLEASE WRITE THE CAMP CODE IN EVERY BOX FOR THE SESSION AND PROGRAM (1 Camper Per Form)

SESSION

6/26-6/30

7/3-7/7

7/10-7/14

7/17-7/21

7/24-7/28

7/31-8/4

8/7-8/11

8/14-8/18

8/21-8/25

8/28-9/1

CAMP CODE

BEFORE CARE

AFTER CARE

CAMP AT THE LAKE ONLY

PAYMENT SUMMARY

TIER PRICING

Tier 1

Tier 2

Total Camp Tuition

BUS STOP

Deposit DUE AT REGISTRATION

($75 per camp session; $25 per each Before Care

Please select a payment plan:

and After Care session)

Send a child to camp!

4-payment plan - April 1, May 1, June 1, and July 1 drafts

(Donate to the Annual Campaign)

This payment plan is only available if registering by March 31

Camp Balance

3-payment plan - May 1, June 1, and July 1 drafts

This payment plan is only available if registering by April 30

(Minus Deposit)

2-payment plan - June 1 and July 1 drafts

This payment plan is only available if registering by May 31

1-payment plan – July 1 draft

This payment plan is only available if registering by June 30

FRIEND

Pay in full plan – available at any time; required starting July 1

REQUESTS

Our camps will try to

PAYMENT METHOD

accommodate all requests

Cash

Visa

AmEx

MasterCard

Discover

Credit cards are required with all applications and are kept on file to guarantee payments.

Name on Card________________________________________________________________________________________________________________________________________________________________________

Card #

Expiration Date

CVV #

Signature______________________________________________________________________________________________________________________________________________ Date ______________________

I understand that my account will be drafted based upon the payment plan I selected above. Should any draft not be honored by my credit card for any reason, I

understand that I am still responsible for that payment in addition to a $20 service charge applied by the YMCA of Montclair. Any additional charges, such as late

pick-up and change fees, will also be drafted.

Signature___________________________________________________________________ Printed Name ________________________________________________________ Date ______________________

FOR OFFICE USE ONLY

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Ymca Of Montclair - Camp Registration Form - 2017 Page 4

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