YMCA Day Camp Registration Form
Date: Starting May 25th
Location: Monroeville Area YMCA
Hours of Operation: 7 AM to 5:30 PM
Registration Fee: $25 per child
Cost: $70 Y Member / $100 Program participants (Weekly Rate)
Morning and Afternoon Snack is provided ( Lunch is not provided Please pack your child a lunch)
For more information contact Justin Marshall / Program Director
Child Name Date of Birth (mm/dd/yyyy)
Parent / Guardian Name #1
Parent / Guardian #1 Name Cell Number
Parent / Guardian Name #2
Parent / Guardian #2 Cell Number
Emergency Contact Name & Number (Besides Parent/ Guardians)
Authorized Pickup List (In addition to the persons listed above) Name - Cell Number
Please list allergies and/or medications
Is there anything else we should know about your child? ( Medical/ Social Concerns)
Child Shirt Size
As the parent of the camper, I authorize my child to attend and participate in all prescribed YMCA camp activities I give the Program Director and any other designated camp staff to administer first aid in the event of an emergency, to secure a physician for any medical or surgical treatment needed for my child. I understand that a conscious effort will be made to locate me or my spouse before action is taken. I understand and accept that this expense will be my responsibility. (Type your name below to sign.
If you are currently a YMCA member and would like us to draft your registration of $25 fee please check the box below.
Yes Draft my Account for $25
No, i will stop by the front desk or pay on the day of check in.
I understand that weekly fees are due on Monday of each week and daily fees are due each morning.
Send me a copy of my responses.
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