YMCA Camp Pinewood "Magic Steps to Growth"

2009 Family Camp Registration

Fill out this form to register for a 2009 Family Camp Weekend. You may use the SUBMIT button to send this registration via e-mail or print it out and mail or fax it to Camp Pinewood. Fax number (231) 821-0487.
A nonrefundable deposit of $100 is necessary for your registration to be complete. Any registration form received without credit card information will not be guaranteed a spot until payment is received. If you prefer you may call in your credit card information after submitting this registration form or mail a check.
Phone number (231)821-2421.

Your Information
Family contact person:
*Family Name:
*Address:
*City:	State: Zipcode:
*Home Phone:
*Cell Phone:
*Parent E-Mail Address:
Re-enter Parent E-Mail Address:

YMCA Member? No Yes - YMCA Card#

Name of YMCA:

Session Information

We would like to register for:

2009 Memorial Day, May 22-25

2009 Labor Day, September 4-7

Are you willing to share a cabin with another family or member Yes No

If "Yes" please specifiy the family:

Campers Attending		Price per family		To Be Charged
Family Camp Pricing ( )
Children under the age of 5 attend free, please DO NOT count them in the number attending to calclate price.
	1-2 campers in my Family		$300	$
	3 campers in my Family		$420	$
	4 campers in my Family		$520	$

Do you have more than 4 campers? Each additional camper after 4 will be $75.00
		Number of Campers x $75.00		$
Total				$
Families preferring to bring their own tents and tent camp on site rather than stay in a cabin will receive $50 off the above price

Camper Information Please list all campers attending, ages and special consideration so appropriate programming can be planned. Children under the age of 5 attend free, but please do include them in the list of participants below.
Camper's Name	Age	Special Needs, Dietary Restrictions, Allergies Please let us know of any special needs your family has while attending. This may include handicap accessibility, vegetarians, food allergies, etc.
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Overnight Adventure Trip

We are currently exploring the option of offering an overnight adventure trip out of camp during the weekend for our older children and adults. Possibilities include backpacking, canoeing, and biking. Meals would be over a fire or camping stove and accommodations would be tent camping. Camp Pinewood would supply all necessary equipment other than clothing. If this is an option that would appeal to members of your family, please check below. As time gets closer and based on interest you will be contacted with more details of potential trips!

Yes, members of my family would be interested in an overnight adventure trip, if available

Desposit/Refund Information and Release

PLEASE READ ALL OF THE FOLLOWING AND CHECK YES TO COMPLETE FORM:

A $100 non-refundable deposit is required for each camp and must accompany this application. Any applications submitted without payment information will be held and not processed until payment is received. Registrations received within 3 weeks prior to the beginning of camp are required to pay the full fee at the time of registration. Final payments are due 3 weeks before camp begins.

** I GIVE THE CAMP PERMISSION TO CHARGE MY CREDIT CARD ON FILE
FOR THE REMAINING BALANCE IF NOT PAID BY THIS DATE**

Cancellation refunds will be given for the camp fee minus the deposit up until two weeks prior to arrival. After this time there are no refunds available. There will be no refunds when a child goes home early in case of disciplinary action or homesickness.

* Yes, I or We (parents/guardians) have read and agree the above statement.

I/We approve this application and certify that our child is in good health.

I do hereby give permission to YMCA Camp Pinewood to transport the child named above off the camp property for the purpose of medical care or program activities as deemed appropriate by the Camp Director.

I hereby authorize the Camp Health Officer to provide for and secure treatment of general health issues for the minor named above. I understand that my child may be dismissed from the program if their behavior or actions are not in keeping with camp goals and policies. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by the camp director to hospitalize, secure proper treatment for, and to order injection, anesthetic, or surgery for the child named above. The YMCA does not furnish accident/illness medical insurance. Medical expenses, including prescription drugs, will be the responsibility of the parents or guardians.

The YMCA of Chicago has my permission to use photographs taken of my child while at camp for promotional purposes.

* Yes, I or We have read and agree to the above statement and submit registration.

Payment Information

Total Amount: $

You may pay in full or pay a deposit of $ .00 (Minimum Deposit is $100.)
The balance is due June 1st, 2009.

I prefer to to mail in my form and payment.

YMCA Camp Pinewood
4230 Obenauf Road
Twin Lake, MI 49457

I prefer to call in my credit card information

Note: This is NOT a secure site. We will not accept credit card information online, please submit this form and call our office
at 231-821-2421 with your credit card information.

YMCA Camp Pinewood
4230 Obenauf Road
Twin Lake, MI 49457

Fax:
(231) 821-0487

Phone:
(231) 821-2421