Camp Woodstock YMCA 2009 Registration Form

  • Summer Camp ages 7-14 (2 weeks) $1,230
  • Summer Camp ages 7-14 (1 week) $740
  • Teen Adventure Trips ages 14-16 (1 week) $830
  • Leaders in Training (LIT) ages 15 (4 weeks) $1,680

$200 non-refundable/non-transferable deposit for each session per child.

The YMCA strives to serve all people regardless of ability to pay.
Financial assistance information is available at our ofice. 1 (800) 782-2344

All programs are open to everyone, without regard to race, sex, color, religion or national origin.

 
CAMPER'S INFORMATION
* Campers Last Name
* Campers First Name
* Date of Birth
* Gender
* Grade
* School
* Campers Address
* City
* State
* Zip
* With whom does the camper live
Email Address
* How did you hear about Camp Woodstock YMCA
* This will be my ___ year at Camp Woodstock YMCA
 
MOTHER'S INFORMATION
Mother's Last Name
Mother's First Name
Mother's Home Phone
Mother's Work Phone
Mother's Cell Phone/Pager
Mother's Email Address
Camp Woodstock YMCA Alumni? Yes No
Mother's Occupation
 
FATHER'S INFORMATION
Father's Last Name
Father's First Name
Father's Home Phone
Father's Work Phone
Father's Cell Phone/Pager
Father's Email Address
Camp Woodstock YMCA Alumni? Yes No
Father's Occupation
 
ADDITIONAL EMERGENCY CONTACT
* Emergency Contact Full Name
* Emergency Contact Relationship
* Emergency Contact Home Phone
* Emergency Contact Work Phone
 
PLEASE CHECK SESSION(S) DESIRED
TWO WEEK SESSIONS ($1,230)
Session 1 June 28 – July 11
Session 2 July 12 – July 25
Session 3 July 26 – Aug 8
Session 4 Aug 9 – Aug 22
ONE WEEK SESSIONS ($740)
1A Session June 28 – July 4
1B Session July 5 - July 11
4A Session Aug 9 – Aug 15
4B Session Aug 16 – Aug 22

TEEN ADVENTURE TRIPS ($830)
T1 Maine Whitewater Raft & Climb June 28 – July 4
T2 Lake George Sailing July 5 – July 11
T3 Cape Cod/Martha’s Vineyard Beach & Bike July 12 – July 18
T4 Maine Ocean Kayak & Rock Climb July 26 – Aug. 1
T5 Cape Cod/Martha’s Vineyard Beach & Bike Aug. 9 – Aug. 15
T6 5 States in 7 Days Aug. 16 – Aug. 22
LEADERS IN TRAINING (LIT) ($1,680)
LIT Session 1 June 28 – July 25
LIT Session 2 July 26 – Aug 22
I will be staying at camp between sessions ($65)

 
IMPORTANT
* If sessions I have requested above are full, my second choice would be
Cabin Mate Request (only one name will be guaranteed)

(Cabin mate request must be similar age. Request must also appear on other camper's card. NO EXCEPTIONS.)

 
CAMPER'S COMMITMENT

* I want to become a camper at Camp Woodstock YMCA. If accepted I agree to abide by the camp's code of conduct and camp rules. I will do my best to make this a good experience for myself and my fellow campers. I understand that failure to live up to this promise might result in my dismissal from camp. (Without a refund.)

* Camper Agreement Please write camper name
Today's Date
 
PARENT/GUARDIAN AGREEMENT AND REFUND POLICY

* I approve this application, and certify that the proposed camper is capable of such an experience. I agree to have a health form signed by a physician or his designee that includes current medication orders and physical exam. This exam must have been given within 24 months of the camper's arrival date. The deposit of $200 per session, per camper is for the purpose of securing your child's reservation at camp and as such is neither refundable nor transferable. The balance of the camp fee is due May1st. Any refund of the balance will only be considered upon written request clearly stating the special circumstances (medical, emergency, etc.) why the camper is unable to attend camp. A camper leaving camp before the end of the session for medical (not homesickness or behavior) or emergency reasons will receive a pro-rated refund for the days missed.

I hereby grant permission for the applicant to participate in all planned camp activities and programs including out-of-camp trips by camp vehicle, biking, horseback, or hiking, etc., understanding that competent leadership will be provided. I authorize the Camp Director and Camp Nurse to seek emergency medical attention for my child in the case of accident or illness if I cannot be reached by phone. I authorize the YMCA to have and use the name, photographs, slides, and video tape of the person named on this application in camp promotional materials. I understand that cabin mate requests are only guaranteed if both campers of similar age request each other.

* Parent/Guardian Agreement Please write parent/guardian name

The YMCA is a membership organization. Camper's membership fee is included within each session's fees.

YOUR BALANCE OF THE CAMP FEE IS DUE MAY 1, 2008. PLEASE INDICATE BELOW WHETHER WE MAY CHARGE YOUR CAMP BALANCE TO YOUR CREDIT CARD ON MAY 1, 2008. PLEASE MAIL THE “LETTER TO MY LEADER” PRIOR TO YOUR CHILD'S CAMP DATE.

 
DISCOVER/MASTERCARD/VISA AUTHORIZATION
* I wish to have my balance due charged on the same card on May 1, 2008 No Yes
To secure a reservation, you must make a minimum payment of $0 (this is the total deposit amount per child per session)
* Please charge $ to my
* Card #
* Expiration Date
* Cardholders name
* Initials of Authorized User
My child's total fee(s) (include registration fee): $ 0
My child's total non-refundable deposit per 0 session(s): $ 0
I would like to give $ ____ to the Strong Kids Campership Campaign
for financially disadvantaged children
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