2012 YMCA of WNC Hendersonville Branch Winter Break Camp Registration Checklist

The following information must be received before a child is able to start the program. Please note that many programs fill quickly, and early registration is recommended. There is a one week waiting period from the date the completed application is received until the date the child is able to start the program. Incomplete forms will delay a childs start date.

Campers Name: _______________________________________ Forms

Youth Information Form - You are required to complete a new Youth Information Form Winter Break Camp Policy Signature Form

annually. Please note that we cannot use the form from the previous summer camp or school year. Please read our policies and procedures. Parent signature required.

Camp Selection Form - Select the camp dates you would like your child to attend.
Individualized Care Plan Form (Optional) Please complete if you noted on the Youth Information Form that your child will be taking a prescription medication at the Y program and/or has a special need/disability. A Youth Development Director will review every ICP and will call to discuss with parents if necessary to determine how to best meet the campers needs. Discipline and Behavior Management PolicyPlease read, sign, and return

Please check if submitting multiple registrations and list the names of children:
_________________________________

Current Photo of Child (please place on the Youth Information Form in the spot labeled
photo.)

Registration Fee and Deposit

The Registration Fee and half the daily fee for all days you are using are required upon registration. Registration Fee: $35 per child or $50 per family Daily Deposit: Attending ________ # of days x daily fee = $___________ due Daily fee $40 (daily deposit $20) Daily Fee for YMCA Members $30 (daily deposit $15) Payment Method: Check # _______

Other $ _____________

Cash Money Order Credit Card

Total Payment Amount Enclosed Now $ ___________

Daily Balance: Your balance for each day of camp is due the day before by 6pm

Parent/Guardian Signature______________________________________