Delaware Family Ymca 2017 Summer Camp Registration Form (Page 4 of 4) in pdf

2017 Summer Camp Registration Form

DELAWARE FAMILY YMCA

2564 Delaware Avenue, Buffalo, NY 14216

P: (716) 875-1283 F: (716) 875-0305

FIELD tRIP ACknoWLEDGEMEnt

[ ] Yes [ ] No

I give my son/daughter permission to attend all Y field trips for the sessions that he/she is registered. My child also has

my permission to participate in swimming activities on field trips, including aquatic amusement park activities.

PERMISSIon to SUPERVISE APPLICAtIon oF toPICAL ItEMS

(Sunscreen, Bug Spray, Lip Balm)

Type of Topical Item ___________________________________________________ Prescription # _______________________________

Start Date_____________ End Date _____________

Days to be Taken

Time of Day __________________________________

Amount (Dosage) _______________________________

[ ] Yes [ ] No

I request that the camp staff supervise my child taking the above medication or applying the topical items as indicated.

I acknowledge that the information stated on this form is accurate and factual.

Parent/Guardian Signature onLY: ________________________________________________________________________________________________________

Date: ______________________________

REGIStRAtIon & REFUnD PoLICIES

• Space is limited in all YMCA programs. We encourage early registration for our popular camp programs to avoid being closed out

of the sessions of your choice.

• Registration begins January 1 for the 2017 season.

• A non-refundable, non-transferable deposit must accompany each week selected. This is deducted from the weekly fee.

• $10 registration fee per child per week 1/1/17-2/28/17. $20 registration fee per child, per week 3/1/17-9/2/17.

• In the case of serious or prolonged illness or injury, all paid fees (except the deposit) will be refunded with a written note from

your child’s physician.

• Payment in full is required two (2) weeks before each week of attendance.

• Children will not be admitted into camp without a completed health form and proof of immunizations.

• Failure to make payment on time may forfeit your child’s spot.

• Campers are assigned by the grade they will be entering in September 2017. Requests to be assigned with other campers cannot

be guaranteed.

• If you pick up your child after 6:00 pm, a late fee of $20.00 per child will be applied to your bill. Consistent late pick-up will result

in dismissal from the program.

• Prices are subject to change without notice.

AFFoRDAbLE

Financial assistance is available through our Annual Campaign, which helps us to make camp accessible to everyone. Additionally,

the YMCA accepts third-party payments through the Department of Social Services and allows children to earn their way to camp

through a candy sale January 1-July 1. The deadline for financial assistance is June 1, 2017. Call or visit your branch for more

information.

17DL Camp Reg Form 170124

Delaware Family Ymca 2017 Summer Camp Registration Form Page 4