Sault Ste. Marie YMCA Summer Day Camps 2013

YMCA DAY CAMP REGISTRATION FORM ‐ 2013
FOR CAMPER: ‐ First / Last
Indicate desired camp for each week; this form will remain on file throughout the summer to allow for additions / changes.
WK DATE CAMP
PA Day June 28 th
1 July 2 ‐ 5 (4 Days)
2 July 8 ‐ 12
3 July 15 ‐ 19
4 July 22 ‐ 26
5 July 29 ‐ August 2
August 6 ‐ 9
6
(4 Days)
7 August 12 ‐ 16
8 August 19 ‐ 23
9 August 26 ‐ 30
EXTENDED
HOUR CARE
AM PM
AM PM
AM PM
AM PM
AM PM
AM PM
AM PM
AM PM
AM PM
AM PM
AMOUNT
PAID
$ $
$ $
$ $
$ $
$ $
$ $
$ $
$ $
$ $
$ $
SCHEDULED
PAYMENT
AMOUNT
DATE
PAID
STAFF
INITIAL
AUTHORIZATION:
⇒ Upon registration of my child at the Sault Ste. Marie YMCA or Camp Korah Day Camps, I permit my child to participate in a full range of camp activities including off‐
site activities, and I authorize Camp Managers and their appointee in the event of an accident or illness affecting the above named camper; to authorize on my behalf
all procedures, including admission to hospital and necessary treatment therein, as he/she may deem essential for the care and well‐being of the camper. Such action
shall be taken only when immediate contact with the undersigned cannot be made.
⇒ I authorize the Sault Ste. Marie YMCA day camp staff to apply sunscreen as necessary to my camper. I understand that I should supply sunscreen, labeled with my
child’s full name.
⇒ I have read & agree to the Standards of Behaviour, listed in the Day Camp brochure, and will review this information with my camper.
Print Name:
Optional Donation: We are grateful to camp families, local businesses, and the United Way for supporting our
Subsidized Day Camp Program. Please consider joining others in our community and help give a child a camp
experience that they might not otherwise have. Donations are tax deductable and receipts will be issued.
Signature: Date:
If you are unable to sign the above AUTHORIZATION as written as you do not agree in part or whole, please block out sections you Do Not
Authorize and sign and submit. Camper will be registered and your “amendments” noted by Camp Manager(s). We ask that you provide
written procedures we should follow in the event of an accident or illness effecting the above camper.
ATTACH A RECENT
picture of camper here
Registration will not be processed without photo
How did you hear about our summer programs?
Please check all that may apply:
sootoday.com
Billboard
local2.ca
Sault Star
Radio Ad
TV Ad
YMCA Website
Word of Mouth
YMCA Staff Member
Other:
I would like to donate:
$10 Other Amount
$ _____________________