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Glen Cove
YMCA of Long Island
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Search for:
Glen Cove YMCA Camp Registration 2012
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Required Fields
Child Information
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Child's Name:
Birth Date:
Date and time
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Age:
Choose
3
4
5
6
7
8
9
10
11
12
13
14
15
16
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18
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Home Street Address:
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Town:
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Zip:
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Home Phone:
Gender:
-choose-
Boy
Girl
Grade:
-Choose-
Entering Pre-K
Entering K
Entering 1
Entering 2
Entering 3
Entering 4
Entering 5
Entering 6
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Mother's Name:
Mother Phone (Mobile):
Mother Phone (Work):
Father's Name:
Father Phone (Mobile):
Father Phone (Work):
Email Address:
How did you hear about us?:
Camp Desired: Session 1
(June 25 - July 13)
Session 2
(July 16 - August 3)
Session 3
(August 6 - August 24)
Kiddie Kamp (3-5 yrs)
Half Day Kiddie Kamp:
1
2
3
Full Day Kiddie Kamp:
1
2
3
Youth Camp (1st - 6th)
Youth Camp Session:
1
2
3
Grade:
-Choose-
Entering 1
Entering 2
Entering 3
Entering 4
Entering 5
Entering 6
Too Kool For Kamp (7th - 9th)
Too Cool for Camp Session:
1
2
3
Grade:
-Choose-
Entering 7
Entering 8
Entering 9
Sports Camp:
1
2
3
Grade:
-Choose-
Entering 3
Entering 4
Entering 5
Entering 6
Extended Care
Session 1:
-Choose-
Session 1 AM
Session 1 PM
Session 1 Both
Session 2:
-Choose-
Session 2 AM
Session 2 PM
Session 2 Both
Session 3:
-Choose-
Session 3 AM
Session 3 PM
Session 3 Both
Transportation
1
2
3
If Pickup/Dropoff location are different from the home address, please provide addresses:
Pickup
Street Address:
Town:
Zip:
Drop Off
Street Address:
Town:
Zip:
Please provide any special directions:
Medical Information
Allergies:
Medication:
Authorized to Pick Up
(other than parent)
Name:
Phone:
Relationship:
Unauthorized to Pick Up
(Legal Documentation Required - see below)
Unauthorized Name:
Unauthorized Phone:
Unauthorized Relationship:
Legal Documentation Required.
Please upload a scanned document here,
or bring to the YMCA.
Upload:
Upload file
Permission Slips
I,
give permission for my child
to participate in all the Summer 2012 Camp activities planned for the days attended. I give permission for my child to leave the YMCA at Glen Cove building to participate in Rainy Day Activities (2nd grade & up). I understand that photographs taken during the camp season may be used for publication. I understand that I must have a completed medical form signed by a physician on file at the YMCA before the first day my child begins camp. I have read and will adhere to the policies outlined above.
Signature:
Signed Date:
Date and time
Now
Refund Policy
I understand that before 5/31 a 25% service fee will be charged if any part of my child's camp needs to be refunded. After 5/31 NO REFUNDS WILL BE ISSUED. There will be a $10 charge for all changes in registration.
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Signature:
*
Signed Date:
Date and time
Now
Acknowledgements
*
I hereby acknowledge that the above information is correct: