YMCA Summer Camp Connections at Our Lady of Grace Registration Form
Complete registration form with check made payable to the Towson YMCA or submit credit card information. When registration is complete, parents will receive a Camp Connection Packet. Mail to: Camp Connection Our Lady of Grace c/o YMCA, 18310 Middletown Road, Parkton, MD 21120
A $25 non-refundable deposit for each week that is signed up for and a one time $30 registration fee is due along with this form. Deposits are non-refundable and non-transferable (includes one T-shirt). Each deposit paid is put toward that week’s tuition payment. There is a sibling discount of $15 per week per child after the first child. Registration deadline is April 5, 2005. Once your application is accepted, there will be the option to receive a 10% off your total payment if paid in full by April 19, 2005.
Camp Calendar (1 Week Sessions) - Please check all that apply
Session 1: The Orient June 13 - June 17
Session 2: 7 Wonders of the World June 20 - June 24
Session 3: Bible Camp June 27 – July 1
Session 4: The Forgotten States July 4 - July 8
Session 5: Walk like an Egyptian July 11 – July 15
Session 6: Pirates July 18 - July 22
Session 7: Christmas in July July 25- July 29
Session 8: Space Mythology August 1- Aug. 5
Session 9: Trains August 8- Aug. 12
Total Weeks Registered:
Camper’s Name ______Boy Girl
Address ______City ______State ______Zip ______
Home Phone ______Age ______Date of Birth ______SSN# ______
Mother’s Name ______Employer ______
Work Phone ______Cell Phone ______
Father’s Name ______Employer ______
Work Phone ______Cell Phone ______
Emergency Contact ______Relationship ______Day Phone ______
Membership Type Member Non-Member
Before & After Camp Care: (if needed) Arrival Time ______Departure Time ______
Payment Method: Check Enclosed Master Card Visa Discover AM Express
Credit Card # ______Card Exp. Date ______Card Holder’s Name (Print) ______
Specify T-Shirt size (Youth sizes) ____S ____M ____L ____XL
PARENT’S AGREEMENT: In signing this agreement for my child, I certify that he/she is able to participate fully in the program unless otherwise stated in writing to the YMCA. In the case of voluntary withdrawal, or if my child is removed from camp, I understand that there will be no refund of camp fees for the period concerned. A $25 non-refundable, deposit per child per week must accompany registration form. Each week’s $25 deposit is applied to that week’s tuition. The deposit is non-refundable and non-transferable. I agree to have all the necessary forms completed and submitted to the YMCA along with the balance of all program fees at least 2 weeks in advance of each session.
Parent/Guardian Signature ______Date ______
I further agree to give the YMCA permission to use any photographs or video footage of my child for promotional purposes or other legitimate reasons.
Parent/Guardian Signature ______Date ______
Names of persons who have permission to pick up your child ______
FOR OFFICE USE ONLY: Registered By: ______Date: ______