Delaware Family Ymca 2017 Summer Camp Registration Form Page 2
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42017 Summer Camp Registration Form
DELAWARE FAMILY YMCA
2564 Delaware Avenue, Buffalo, NY 14216
P: (716) 875-1283 F: (716) 875-0305
DELAWARE FAMILY YMCA SUMMER CAMP PRoGRAM FoRM
Use this form to register for camp by checking the appropriate box for the desired weeks. The first price that is listed is for Y members, followed
by program member price. For camps with the 3 day option, please circle the days attending. There is no camp July 4, 2017. Camps are prorated
for the week of July 3-7, 2017.
WEEk STARTING
QUESTIONS? Call 716-875-1283 with questions or for more information!
6/26 7/3 7/10 7/17 7/24 7/31 8/7 8/14 8/21 8/28
Young ExPlorErs
FEE
Ages 3-entering kindergarten
Delaware Family YMCA
Per
$158
Week
$193
2564 Delaware Ave, Buffalo
DAY CAMP
Entering grades 1-6
$158
Delaware Family YMCA
Per
Week
$193
2564 Delaware Ave, Buffalo
ArTs & THEATrE CAMP
Entering grades 3-8
Tapestry Charter School
Per
$158
Week
$193
65 Great Arrow Dr, Buffalo
TEEn CAMP
Grades 7 & up
Delaware Family YMCA
Per
$158
Week
$193
2564 Delaware Ave, Buffalo
lEADErs In TrAInIng
Entering grades 7 & 8
$158
Delaware Family YMCA
Per
Week
2564 Delaware Ave, Buffalo
$193
CounsElors In TrAInIng
Entering grades 9 & up
$95
Delaware Family YMCA
Per
Week
$116
2564 Delaware Ave, Buffalo
YMCA Member
[ ] Yes [ ] No
PAYMEnt InFoRMAtIon
The deadline for financial assistance is June 1, 2017.
[ ] Check
[ ] MasterCard
[ ] Visa
[ ] Discover
[ ] AMEX
[ ] Automatic Draft
(call branch for details)
Weekly Deposit Enclosed $ _________ (
A non-refundable, non-transferable deposit must accompany each week selected, which is deducted from the weekly fee.)
Card # _____________________________________________________________________
Exp. Date _____________________
Signature _____________________________________________________
17DL Camp Reg Form 170124
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