Forms must be postmarked or delivered NO EARLIER than March 1. Thank you. - One Camper Per Page
Name of Camper/CIT: 
Parent or Guardian: 
Mailing Address:  Zip Code:
Street Address:  City:  
Home Phone:  Day Phone:
E-Mail: Cell Phone:
Please check: Boy     Girl  Birth Date:
Age as of 9/1/08:  School Grade in September 08:
   
 Extended
Early
 Deposit Office Office Volunteer/Work Exchange Opportunities
 
9-3
3-4
3-5
8am
 
    
Kitchen Mom, 2 hours per day
June 23 - 27  
 
 
 
 
    
Nursing Skills, health checks Monday am
June 30 - 3  
 
 
 
 
    
Teach campers about/how to
July 7 - 11  
 
 
 
 
    
Arts and Crafts Instructor Work Exchange
July 14 - 18  
 
 
 
 
      
July 21 - 25  
 
 
 
 
      
July 28 - Aug 1                
August 4 - 8  
 
 
 
 
     Office Use Only:   Conf  Imm  Reg  Comp

Please check Weeks & Length of Day
Fees to Mail with Registration:
$10 non refundable registration form
$50 per week per camper not refundable or transferable after 5/1.
Each $50 deposit applies to camp fees FOR THAT WEEK ONLY.

 
I give permission for my child to participate in all regular camp activities; to receive first aid treatment as needed; to be taken to a doctor or hospital and treated if I cannot be reached in an emergency. Any pictures of camp can be used for publicity and treated as property of the YWCA. I understand that I can not send my child to camp when he/she is ill.
Signature of Parent or Guardian:
Emergency Numbers (someone other than parent):
Name: Phone: Relationship:
Name: Phone: Relationship:
Sign Here to authorize your child to walk home:
Any Allergies to Food or Insects?               Which?
Does your child take medication regularly?    yes  no             If yes, please explain on back of page (over)
Will your child need this medication during camp?   yes   no
Please list any activity limitation your child may have or explain any reason your child may be afraid of the water
(use back for more space):
If your child has difficulty relating to others or if there is anything else which will help us make camp a positive experience, please explain on the back of this page.
Mail To: YWCA, Ferry Hill Road, Marshfield 02050 with a CURRENT copy of immunizations & your deposit.
No space will be reserved without application, fee & immunizations.