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Youth Development
Glen Cove
YMCA of Long Island

Glen Cove YMCA Camp Registration 2014

*Required Fields

Child Information

Birth Date:
Camp Desired:   Session 1 (June 30 - July 18)    Session 2 (July 21 - August 8)    Session 3 (August 11 - August 29)
Kiddie Kamp (3-5 yrs)

Half Day Kiddie Kamp:

Five-Day Kiddie Kamp:

Three-Day Kiddie Kamp:

Youth Camp (1st - 6th)

Youth Camp Session:

Youth Camp Option (Weekly Options for Session 3 only):

Too Kool For Kamp (7th - 9th)

Too Cool for Camp Session:

Sports Camp:

Extended Care



If Pickup/Dropoff location are different from the home address, please provide addresses:  

Drop Off

Medical Information


Authorized to Pick Up (other than parent)

Unauthorized to Pick Up (Legal Documentation Required - see below)

  Legal Documentation Required.
Please upload a scanned document here,
or bring to the YMCA.

Permission Slips

give permission for my child
to participate in all the Summer 2014 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.
Signed Date:

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.
*Signed Date: