Child’s Name: ________________________
Weeks Attending: _______________________
Summer Day Camp Registration Checklist
_____ YWCA Membership application form with payment OR current YWCA Membership
_____ Payment of last WEEK of program for the child/ren Receipt# __________
_____ Front Desk information page with bottom section completed by YWCA Employee
Charge Card used? _____ yes _____ no
_____ Summer Day Camp Enrollment Form / with T-shirt size circled and Financial
Acknowledgement signed, email section complete.
_____ Medical Health History Form (front) completed by parent, signed and dated
_____ Medical Health History Form (back) immunizations and sunscreen portion completed, signed,
dated by: Doctor, Nurse Practitioner or Physicians Assistant.
ALL CAMPERS NEED THIS COMPLETED!
_____ Current Physical- No older than 2 years (If we have one on file, this may be used)
_____ Written Medication Consent (if needed for on site medications)
_____ Birth Certificate- needed for Canadian field trips
_____ Permission Slip for Week 3- Fallsview, Canada
_____ Approval Letter from DSS
_____ Caseworker Name: _______________
_____ Caseworker Phone Number: _______________
INCOMPLETE REGISTRATIONS WILL NOT BE ACCEPTED
*To begin camp on 6/25, all completed paperwork must be submitted to the
YWCA by 4:30pm, on 6/18. Paperwork received after 6/18 will result in your child not
beginning camp until Week 2.