Deposit/Refund Information and Health Release
PLEASE READ ALL OF THE FOLLOWING AND CHECK YES TO COMPLETE FORM:
A
$100 non-refundable deposit is required for each session and must
accompany this application. Any applications submitted without payment
information will be held and not processed until payment is received.
Registrations
received within 2 weeks of the beginning of the session are required to
pay the full fee at that time. Payment is due 30 days prior to your
camp session.
** 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.
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.
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