Camp Combe Fall 2007 - YMCA

Parent/Guardian Agreement
I approve this application and certify that the proposed student is
capable of such an experience. I authorize the YMCA to have and use
photographs, slides, moving pictures, or television video tapes of the
person named on this application as may be needed for its records or
public relations program. I understand that the director of the YMCA
reserves the right to refuse applications of, or to sever connections
with, any individual whose influence is judged harmful to the best
interest of camp.
Parent/Guardian Signature __________________________________
Date: ___________________
Check enclosed for $__________(Make checks payable to YMCA).
Please charge my: ❑ Visa ❑ Mastercard ❑ AMEX
for amount: $__________
Card #___________________________________________________
Exp Date: _____________________
Signature: _______________________________________________
Questions Call us at 845-526-0808