8 / Week 9 / Week 10
6/22-6/26 / 6/29-7/3 / 7/6/-7/10 / 7/13-7/17 / 7/20-7/24 / 7/27-7/31 / 8/3-8/7 / 8/10-
8/14 / 8/17-8/21 / 8/24-8/28
Camp Group / Fee
Tadpoles,
Age 3 / M,W,F
1/2 day / $100M/$165NM
Chipmunks,
Ages 4-5 / M-F
1/2 day / $210M/$275NM
Raccoons, Kindergarten / M-F
Full Day / $290M/$355NM
Hawks,
Grades 1-2 / M-F
1/2 day / $210M/$275NM
Owls,
Grades 1-2 / M-F
Full Day / $290M/$355NM
Coyotes,
Grades 3-5 / M-F
Full Day / $310M/$375NM
Explorers,
Grades 6-7 / M-F
Full Day / $400M/$465NM
Total # Weeks / ______ / Total Tuition
Early Dropoff
All Ages / 8-9 a.m. / $5/Day
Lunch Bunch
For ½ day camps / 12-1 / $5/Day
Late Care
All Ages / 3:30-4:30 / $5/Day
Total Add-ons
Natures Adventures Summer Day Camp Registration Form
Please Note: Full SSYMCA members are members of the South Shore Natural Science Center.
Registration is on a first-come first-served basis.
Registration is not complete until health and permission/photo release forms have been turned in.
Camper Info (One form must be filled out for each camper):
Camper’s Last Name: ______First Name: ______
Address: ______City, State, ZIP: ______
Male Female Birth Date: ______Age: ____ Grade (Fall 2015): _____ Home Phone: ______
Parents/Guardians Info
Mother/Guardian:______Day Phone: (______) ______
Address: ______Cell Phone: (______) ______
______Email: ______
Father/Guardian: ______Day Phone: (______)______
Address: ______Cell Phone: (______)______
______Email: ______
Payment Info:
Line 1: # of weeks registering for: _____ Deposit required: ($50 x # of weeks): $______OR Payment in Full: $______Line 1 Total: $______
Line 2: Camp T-Shirt: $10 Size: CHILD: Sm Med Lg ADULT: Sm Med Lg Line 2 Total: $______
Line 3: Membership: Current SSNSC Member Current SSYMCA Member Join today as a SSNSC Member ($65) Line 3 Total: $______
Line 4: I would like to make a gift to SSNSC’s Send a Kid to Camp Campaign: $5 $10 $25 $50 Other $_____ Line 4 Total: $______
Payment Method: Money Order Check Enclosed (payable to South Shore YMCA) Cash Grand Total: $______
Credit Card: Master Card Visa America Express Discover
Credit Card #: ______Expiration Date: ______Amount Enclosed: ______
Name on Card ______CCID: ______Signature: ______