Camp Addition / Change Form - Ymca Of Metropolitan Washington
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1
2Camp Addition / Change Form
YMCA of Metropolitan Washington
Section 1: Parent Information
Parent/Guardian Name: __________________________________________________________
Member Number: __________________________
Address: ___________________________________________________________________________
Apartment #: _______________________________
City:_____________________________________________________
State: ____________________________
Zip: ________________________________
Email: ____________________________________________
Primary Phone: ________________________
Cell Phone: _______________________
Section 2: Camp Addition / Change Information
CHILD’S NAME
CHANGE FROM
ADD CAMP
Camp Name:
Camp Name:
1.
Code #:
Week #
Code #:
Week #
Camp Name:
Camp Name:
2.
Code #:
Week #
Code #:
Week #
Camp Name:
Camp Name:
3.
Code #:
Week #
Code #:
Week #
Camp Name:
Camp Name:
4.
Code #:
Week #
Code #:
Week #
Camp Name:
Camp Name:
5.
Code #:
Week #
Code #:
Week #
Section 3: Payment Guidelines
Adding a Camp Information:
All payments are to be paid in full upon completion of this form.
$25 deposit per week of camp. Note: If camp is two weeks or less you will be billed for the full amount.
Paying full amount of camp due today: $_______________ total amount.
Paying $25 deposit today per each week of camp due today: $_______________ total amount.
I agree to bill my card on file today: $ __________________ total amount.
Camp Change Information:
All payments are to be paid in full upon completion of this form.
Paying full amount due today: $_______________ total amount.
I agree to bill my card on file today: $ __________________ total amount.
I have read and agree to the terms & conditions listed above.
Parent/Guardian Signature: _________________________________________________________________
Date: ______________________________
OFFICE USE ONLY:
Accepted By: ____________________________________________________________________________
Date: ____________________________________
Processed By: __________________________________________________________________________
Date: ____________________________________
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