Document Sample
					                       RARITAN VALLEY YMCA – CAMP YOMECA
                            SUMMER DAY CAMP 2011 REGISTRATION FORM
Full Day Camp Prices:
$250 per week for all sessions except session #3, prorated at $200 (No Camp on Monday July 4 )

Half Day Mighty Mites Preschool Camp Prices:
$135 per week Half Day 8:30-12:30 except session #3, prorated at $110 (No Camp on Monday July 4 )
$215 per week Full Day 7:00-6:30 except session #3, prorated at $175 (No Camp on Monday July 4 )

____1 (6/20-6/24)     ____2 (6/27-7/1) ____3 (7/5-7/8) ____4 (7/11-7/15)        ____5 (7/18-7/22) ____6 (7/25-7/29)

____7 (8/1-8/5)       ____8 (8/8-8/12) ____9 (8/15-8/19)      ____10 (8/21-8/26)       ____11 (8/29-9/2)

Specialty Camp Prices:
All specialty camps are $275.00 or $300 (All programs except soccer are half day)
Specialty Camps:
____2 Creative Arts    ____2 Performing Arts/Dance ____4 Cooking    ____ 5 Tennis   ___6 Cooking   ___8 Tennis

____9 Challenger Soccer    ____10 (Creative Building, grades 1-8) (ALL SPEC. CAMPS ARE OPEN TO ALL CAMPERS)
NO SPECIALTY CAMPS Session 3 (July 4 Holiday) and Session 7 (COLOR WAR WEEK)

CIT Program: ____CIT 1 (6/27-7/22) ____CIT2 (7/25-8/19)
Cost is $500.00 for 4 week session. Candidates must apply and go through interview and selection process before

Child’s Name: ___________________________________________                 Start Date: ________________________________

Birth Date: __________________ Age: _____________Grade in Sept, „11:___________ (              ) Male or ( ) Female

Mailing Address: ____________________________________________________________________________________

Mother’s Name:                                                                       Home Phone: ________________________

Address:                                                                     Cell Phone: ________________________________

Employer:                                                                    Business Phone: ____________________________

Business Address:                                                            Business Hours: ____________________________

Father’s Name: _________________________________________________ Home Phone: ________________________

Address: _________________________________________________ Cell Phone: _______________________________

Employer: ________________________________________________ Business Phone: ___________________________

Business Address: _________________________________________ Business Hours: ___________________________

Parent‟s Marital Status:   ( ) Married        ( ) Divorced   ( ) Separated     ( ) Widowed      ( ) Unmarried

Custody Schedule (if applicable):_______________________________________________________________________

If there is a court order restricting visitation/pickup, a copy must be provided, by state law, to the YMCA Business Office
Child’s Doctor: _________________________________________________ Phone #:______________________________

Address: _______________________________________________________Insurance Co./HMO:_____________________

Subscriber‟s Name: ___________________________ Group #:__________________ID#:____________________________

Emergency Contacts: Please list persons authorized to pick up child and or/contact in case of an illness if parents cannot be

Name: _______________________________________________Relationship:_____________________________________

Address: ______________________________________________Home Phone: ___________________________________

Cell Phone: ____________________________________________ Work Phone: ___________________________________

Name: ________________________________________________Relationship:____________________________________

Address: ______________________________________________ Home Phone: __________________________________

Cell Phone: ____________________________________________ Work Phone: ___________________________________

Pick up Authorizations: Please list all persons, at least 18 years of age, who are authorized to pick up your child

1. Name: _______________________________________________ Relationship: _________________________________

2. Name: _______________________________________________ Relationship: _________________________________

3. Name: _______________________________________________ Relationship: _________________________________

4. Name: _______________________________________________ Relationship: _________________________________

5. Name: _______________________________________________ Relationship: _________________________________

Please list any persons PROHIBITED from picking up your child:

1. Name: _______________________________________________ Relationship: _________________________________

2. Name: _______________________________________________ Relationship: _________________________________

Parent’s Signature:     ________________________________________

Print Name:     ____________________________________________
         Child’s Name: _______________________________________________________________________________________
                                                   Raritan Valley YMCA

                                 Parental Authorization and Consent
            Photo/Video Consent: I consent that photographs and videos taken of my child are the property of the Raritan Valley YMCA
             and may be reproduced and publicized as the YMCA desires, free of any claims on my part. If I do not wish for my child to be
             photographed or videotaped, I will notify the business office in writing.

            Walking Trips: I give permission for my child to participate in walking trips within the center’s neighborhood.

            Transportation Consent: I give permission for my child to be transported from the Raritan Valley YMCA to the Village
             Swim Club. I also give consent for my child to take part in and be transported on planned field trips or excursions sponsored by
             the Raritan Valley YMCA.

            Medical Emergency: I give consent to have my child receive first aid by the camp staff, and if necessary, be transported to
             receive emergency care. I authorize representatives from the Raritan Valley YMCA to give consent for any and all necessary
             emergency medical care for my child and I understand that I will be responsible for all charges incurred.

    PARENT’S SIGNATURE:_________________________________________DATE:___________________________

                                                   Parental Agreement
            I understand that staff protects themselves and the YMCA by agreeing not to be alone with YMCA youth or program
             participants outside of YMCA programs. This includes no babysitting, taking children on trips, or having them in their homes
             when others are not present.

            I understand and agree that my child is not permitted to bring toys, playing cards, video games, or any non-school items to the
             YMCA, and understand that if they do so, they will be taken by staff and placed in the returned to parent box.

            I understand that the Raritan Valley YMCA is not responsible for any personal belongings that are lost, stolen or damaged.

            I understand that my tuition payments are due 2 weeks prior to the start of each session. I understand that my child’s space in
             the program as well as my $75 deposit per session, will be forfeited if my payment is not received on time. I also understand
             that memberships and camp deposits are non-refundable, and the camp balance is non refundable once the session has begun.

            I understand that my child will not be admitted to the program until all required documents have been submitted to the business
             office 48 hours prior to the start of camp. I read and understood the camp payment and refund policy.

            I agree to adhere to all camp policies.

  PARENT’S SIGNATURE: _________________________________________DATE:___________________________

I attest that all of the information provided by me is accurate

Parent Signature:                                                                 Child’s Name:
                                             Raritan Valley YMCA
                                    Camper Confidential Form
Child’s Name:                                                        Nickname:

Name/ages of other children in the household:

How does this child get along with siblings?                                                                            N

How does child get along with other children/friends?


Is this your child’s first camp experience? ( ) Yes ( ) No     If no, please describe previous experiences:

What are your child’s favorite activities?                                                                              H

What form of discipline does your child best respond to?

Does your child have any specific fears? Please describe:

In order for our staff to assure your child a happy, meaningful experience at our camp programs, please share any       W
special needs your child may have (i.e. learning, disabilities, limitations, etc)

As parent/guardian of the above participating child, I certify that he/she is in good physical health, has no special
needs, and may participate in all of the activities of the Center’s program, except as noted above.

Parent Signature:                                                             Date:

                   or 732-257-4114 for more information
                                                Raritan Valley YMCA
Camp Philosophy
The camp experience should provide children with an opportunity to make new friends, learn new skills, develop their character,
build their self esteem, and feel safe and accepted. Children should leave camp each day better for their experience having felt
valued and appreciated.

Children gain a sense of independence, learning to succeed and fail with dignity and sportsmanship. Camp teaches children
how to appreciate the accomplishments of others, how to make others feel valued, and fosters responsibility. By watching and
emulating their role models, children learn to display good manners, conduct themselves positively and challenge themselves to
be better people.

Camp should be a home away from home where they may grow and develop to their fullest potential. Most of all, Camp is a
place where a child can be a child free from the worries of peer pressure, bullying and the search to be accepted. At Camp
every child will feel welcome and part of something bigger than themselves. They will be a part of a community where their
individuality is welcomed and supported.

Camp will be based outside at the YMCA facility at 144 Tices Lane in East Brunswick. Children will be transported by bus to
and from the Village Swim Club in the afternoon for swim lessons and free swim.

Registration Information
1. A current YMCA membership required ($60.00).
2. A deposit of $75.00 per session is due at registration. ($50 for Mighty Mites)
3. All forms in camp registration packet are due 48 hours prior to the child‟s first day of camp. There will be no exceptions,
   as the staff need to process the paperwork for the health and wellness of your child.
4. Deposits and memberships are non-refundable, and the camp balance is non-refundable after the session has started.
5. The balance of each session is due 2 weeks prior to the start of the session. Failure to do so will result in cancellation and
   loss of deposits.
6. Payment one week prior to the session must be made by cash or credit card. Checks will not be accepted within
  one week prior to the start of a session.

Traditional Camp 2011*                                              Specialty Camp 2011
Sessions   Dates          Fees        Deposit      Balance Due      Sessions    Camp           Fees      Deposit      Balance Due
1**        6/20-6/24      $250.00     $75.00       6/06             2           Perf. Art/     $275.00   $75.00       6/13
2          6/27-7/1       $250.00     $75.00       6/13                         Dance
3          7/5-7/8        $200.00     $75.00       6/20
4          7/11-7/15      $250.00     $75.00       6/27             2           Creative Art   $275.00   $75.00       6/13
5          7/18-7/22      $250.00     $75.00       7/05
6          7/25-7/29      $250.00     $75.00       7/11             4&6         Cooking        $300.00   $75.00       6/27 & 7/11
7          8/1-8/5        $250.00     $75.00       7/18
8          8/8-8/12       $250.00     $75.00       7/25             5&8         Tennis         $300.00   $75.00       7/05 & 7/25
9          8/15-8/19      $250.00     $75.00       8/01
10         8/22-8/26      $250.00     $75.00       8/08             9           Soccer         $300.00   $75.00       8/01
11         8/29-9/2       $250.00     $75.00       8/15
                                                                    10          Creative       $275.00   $75.00       8/8

** Session #1 has Full Week Rate of $250.00 and the After School Program Rate of $200.00 for RVYMCA students.

*Mighty Mites Preschool Camp follows pay schedule of Traditional Camp and requires a $50 deposit and the
balance due (2) weeks prior to the start of the session.
Traditional Camp Program (June 20 – September 2, 2011) $250.00 per week. Your camper joins other
children to experience the thrill of day camp through a variety of activities including arts and crafts,
instructional and recreational swimming, nature, sports instruction, and games. All children are placed in
age appropriate groups and activities are designed accordingly. Program content and themes change
weekly to maintain variety and excitement. Special events and weekly trips are scheduled to enhance
each camper‟s experience. Camp is from 7:00am-6:30pm daily (early and extended care is included).

Mighty Mites Preschool Camp (Full or Half Day) (June 20 – September 2, 2011) $135 per week for Half
Day, $215 for Full Day. Campers get the experience the best summer day camp can offer. Age
appropriate activities and low camper to counselor ratios make for an exciting summer filled with making
friends, exploring the outdoors, swimming, crafts, sports instruction, creative arts, dramatic play and so
much more. Full Day Camp is from 7:00am-6:30pm daily (early and extended care is included). Half
Day Camp runs from 8:30am-12:30pm daily.

                                       SPECIALTY CAMPS
Creative Arts Camp (6/27 – 7/1) $275.00 per week. Inspire the artist in your child and let creativity
thrive! Young artists will work with a variety of mediums and methods as they develop their artistic skills.
Mobiles from recycled materials, “The Pipe Dream Project” sculptures (the YMCA is helping to keep the
Pipe Dream Project alive), Jackson Pollack Painting, and Dali-ramas are the projects campers will create.
No popsicle stick boxes or macaroni art during this week. Campers will have the opportunity to expand
their creative side and express themselves through art. Very hands on! Limit 30 campers.

Performing Arts/Dance Camp (6/27 – 7/1) $275.00 per week. If your child has the penchant toward the
dramatic…if they love to sing, dance or perform than this is the specialty camp for them. Campers will
participate in improvisational activities and dramatic exercises; be introduced to a variety of different
styles of dance; choreograph their own dance routines; and write, cast, direct and perform their own one
act play/musical for the entire camp as the week end culminating activity. Limit 30 campers.

Cooking Camp (7/11-7/15) and (7/25-7/29) $300.00 per week. BACK BY POPULAR DEMAND!
Campers will learn the basics of good cooking and healthy eating. Campers will experience food tastings
to expand their palate, plan a menu, take a grocery store field trip to purchase their supplies, and learn
proper hygiene and food preparation techniques. Each day the campers will prepare and eat a dish. The
week culminates in the preparation of their planned menu and a lunch to make even the best chefs
jealous. Limit 15 campers per session. EXTENDED PROGRAM 9am-1pm daily

Tennis Camp (7/18-7/22) and (8/8-8/12) $300.00 per week. Learn the basics of tennis or improve your
game. Join us for a week full of skills, drills, fundamentals and fitness all culminating in daily games and
weekly tournaments. It‟s a fun way to learn the game of tennis. Campers will participate in a variety of
creative activities to develop their tennis skills from Tennis Baseball, to Racquet Hockey and more. All
skill levels are welcome. Limit 15 campers per session.

Challenger Soccer Camp (8/15 – 8/19) FULL DAY, $300.00 per week. Explore the world through
soccer. Campers will have fun while working with British coaches to develop physical skills and fitness
levels. Every day is a new adventure! Each day includes an introduction of new skills, fun activities to
practice basic skills of the game and a mini World Cup. Success is measured more by how much is
learned and having fun than by how well you play. Campers swim everyday and attend the weekly trip
with their coaches. Free soccer ball and t-shirt to all participants. Limit 40 campers.

Creative Building Camp (8/22-8/26) $275 per week. Young builders spend the sessions designing and
building their own creative structures. Each day has a theme to challenge even the most creative builders.
Projects range from bridges to skylines to dream homes and more. Campers will use a variety of mediums
to construct their creations. Each camper will leave with a photo portfolio of their work. Limit 30 campers.
                                        Raritan Valley YMCA
                                           144 Tices Lane
                                      East Brunswick, NJ 08816
                                   732-257-4114 Fax 732-257-5762

Dear Camp Parents:

This notice is a reminder of our lateness policy. Please read the policy and sign that you have
received this information.

The Camp Yomeca ends promptly at 6:30pm. Due to state licensing guidelines, we must
conclude the program precisely at this time.

A policy is in effect in which a parent must pay a considerable late fee if the child is picked up
after 6:30pm.

We kindly ask you to consider the staff’s responsibilities outside of the YMCA. Their time is
valuable and they must meet other obligations.


      A late fee of $15.00 per 15 minute intervals will be charged for those children enrolled
       in day camp (example: 6:31-6:45pm = $15.00, 6:46-7:00pm = $30.00).

      Please contact the YMCA if you are anticipating being late. Calling the YMCA does not
       exclude you from paying the late fee. You must find other pick up arrangements and
       notify the Y of the person you are authorizing us to release your child to.

I have read and acknowledge that I have received a copy of the late pick up policy.

Parent’s Signature:                                                   Date:

Child’s Name:

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