Bynden Wood Registration

Counting down to Summer Camp 2010: 2010-6-20 14:00:00 GMT-05:00

2010 Bynden Wood Registration

Camper's Name:

Date Of Birth

Age:

Next School Grade:

First Year Attending Camp:

Male:

Female:

Home Phone:

Family E-Mail:

Parent 1:

Relationship to Camper:

Parent 2:

Relationship to Camper:

Parent 1 Occupation

Parent 2 Occupation

Parent 1 Business Phone

Parent 2 Business Phone

Parent 1 Cell Phone

Parent 2 Cell Phone

Home Address:

City or Town:

State:

Zip:

Emergency Contact
(If the Parent/Guardian cannot be reached, please contact the person listed below)

Name:

Relationship:

Home Phone

Business Phone

Cell Phone:

We will be using the bus service.

Bus Stop to Camp

Bus Stop from Camp

We will provide our own transportation.

Please check all sessions applied for: $100 deposit is required for each camp session.

Deposit or Payment Information:

Total Amount $
Charge my Credit Card:
Credit Card Number:
Security Code:	On the Back of the Card in Signature Box
Cardholder Name:
Expiration Date:

Any Other Comments:

How Did You Hear About Camp?

Additional Information:

After registering an invoice will be sent to each parent.
Prior to camp additional detailed information will be sent to each registered participant.

Age Requirements
Ages 5-13
Deposits & Tuition
A $100.00 deposit is required for each camp session.
• Tuition balance is due by May 1, 2010. Methods of payment accepted: check,
MasterCard, Visa or Discover.
Cancellations & Refund Policy
• All deposits are refundable until February 1, 2010.
• If a cancellation occurs after February 1, 2010, but 60 days before the beginning of
the session, payments will be refunded, MINUS the deposit. After this time, no
refund will be given except as listed below.
• If a cancellation occurs for a physician-documented medical reason all fees, MINUS
the deposit will be refunded.
• If during a session it is advised to send a camper home for medical reasons, the
remaining portion of the session will be refunded.
• No refunds will be made for late arrivals or early departures.
• In case of homesickness, dismissal, or voluntary withdrawal there is NO refund of
any fees.

Please Read:
By clicking the SUBMIT Button below, I have read, understand and agree to the provisions outlined in this document.
I certify that the camper applicant is capable of participating in an active camp experience.

Click here for A CA CEO Peg Smith answers parents' questions regarding H1N1 and summer camp Contact Us South Mountain YMCA PO Box 147 - Wernersville, - PA 19565 telephone: 610.670.2267 fax: 610.670.5010 email: ycamps@smymca.org

"The mission of South Mountain YMCA is to provide a camping experience, educational and other programs that build personal leadership, character and life skills while developing caring, honesty, respect and responsibility in young people, families and communities"