Camp Cory - YMCA of Greater Rochester

PAYMENT
PROGRAM DATES EFT Date COST
ATTENDEE
(please circle who will attend)
FAMILY
Memorial Day May 25-28, 2012 May 1
Labor Day August 31-Sept. 3, 2012 August 1
Daddy & Me September 14-16, 2012 August 15
0-3 years old FREE
4-12 yrs $150
13 and up $180
0-3 years old FREE
4-12 yrs $150
13 and up $180
Dad & 1 Child $200
Ea. Addtl. Child $85
AH/P1 P2 P3 P4
AH/P1 P2 P3 P4
AH/P1 P2 P3 P4
ADULT
Nature’s
Retreat
Spring
Body Peace
LIVESTRONG
Retreat
Fall
Body Peace
June 4-6, 2012 May 15 $165
June 1-3, 2012 May 1
August 24-26, 2012
September 7-9, 2012
August 1
August 15
$185
LIVESTRONG Ambassador:FREE
Guest $100
$185
AH/P1 P2 P3 P4
AH/P1 P2 P3 P4
AH/P1 P2 P3 P4
AH/P1 P2 P3 P4
TEEN
Teen
Sailing
May 18-20, 2012
September 14-16, 2012
May 1
August 15
12-16 yrs $120
AH/P1 P2 P3 P4
12-16 yrs $120 AH/P1 P2 P3 P4
Payment Options
Check (Make Payable to YMCA Camp Cory)
Credit Card (Circle One) Visa MC Discover
I understand that all fees are non-refundable and
non-transferable.
I understand the enrollment is limited and
registrations will be taken on a first-come,
first-served basis.
Card Number
Name on Card
Signature
Exp. Date
Sec. Code
Date
I give consent that the YMCA of Greater Rochester
may use photographs, slides or videos of me as
may be needed for records or for promotional use,
such as brochures, advertisements and the YMCA
of Greater Rochester’s websites.
Deposit is $100/person/program Choose One:
I want to set up EFT Payment (see date draft on program table)
I want to Pay in Full (required if registering after draft date above)
Signature
Date
Attendee
Program Name
$
$
Program Cost
Registration confirmation and a
program handbook will be sent upon
receipt of registration form and deposit.
$
$
Please return completed forms
with payment to:
Total Amount Due
Deposit Enclosed
Balance Due
$
$
$
$
- $
$
YMCA Camp Cory Office
444 East Main Street
Rochester, NY 14604
1-800-981-7092
Fax: (585) 325-1602