Application for Registration 2017

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'Camper' Information

  1. Current Grade

    'Parent 1' Information Copy contact information from 'Camper'

  1. 'Parent 2' Information Copy contact information from 'Camper'


1. I wish to enroll my child in the 2017 Y Country Camp program and agree to pay the established fee. If the camper withdraws at any time once registered, there will be a non-refundable administrative charge of $50. This also pertains if a camper shortens their length of time registered at YCC.

2. Balance of fees must be arranged at the time of registration, due on or before March 31, 2017.

3. The applicant and camper agree to abide by the camp’s policies and regulations. The camp reserves the right to reject any application, or dismiss any camper not conforming thereto or to cancel any program due to insufficient registration.

4. The camp does not assume responsibility for loss or damage to baggage or personal belongings while in transit or during the period of camp. In case of theft, no claim may be made against the camp. The applicant agrees to reimburse the camp for any unforeseen expenses it incurs on the camper’s behalf (special supplies or emergency medical expenses, etc.)

5. All camper limitations, existing conditions (physical, emotional or psychological) and special requirements must be fully disclosed in the camper medical form.

6. The camp and its staff, while endeavoring to exercise reasonable care, assume no responsibility for any accident, The applicant and camper hereby undertake to procure appropriate insurance.

7. Visiting is not permitted at camp with the exception of the established visiting day.

8. In case of illness or accident affecting my child, I hereby authorize you to engage such medical personnel and/or institutions as you may deem necessary and further authorize such medical personnel or institutions to perform those medical procedures, surgical or otherwise, which in their opinions are necessary for the proper treatment of my child.

9. The undersigned consents to the use of the camper’s name, photograph, or any other identification in connection with the camp’s program, exchanges or publicity.

10. I understand that during the course of the summer, my child may be participating in out-of-camp programs, i.e. trips, intercamps. I hereby give permission for my child to participate in these programs.

11. I hereby certify that all information given is true and correct and agree to all the provisions of the agreement. This agreement is drawn up in English through the mutual consent of both parties. Cet accord a été rédigé en anglais, par consentement mutuel des deux parties en cause.

12. Please note that included in the fees for full paying full session campers is a YM-YWHA membership. This membership begins the day upon registration and goes for one year.


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