YMCA Camp Pinewood "Magic Steps to Growth"

2008 Leadership camp registration

Fill out this form to register for a 2008 leadership camp session. 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 will be charged per session. Any registration form received without credit card information will not be guaranteed a spot in the camp session chosen. If you prefer you may call in your credit card information after submitting this registration form. Phone number (231) 821-2421.

PLEASE NOTE: Leadership June 22- 27, 2008 Girl's sessions are now full. Boys are still available.

*Camper's Full Name:	Male Female
	This is my year at Pinewood:
*Age at Camp(7-16):	Grade Entering in 9/07 *Birthday (mm/dd/yy):
*Parents/Guardians Name(s):
*Address:
*City:	State: Zipcode:
*Home Phone:
*Cell or Pager:
*Emergency Contact Name:
*Emergency Phone:
*Parent E-Mail Address:
Re-enter Parent E-Mail Address:

Mother's Occupation	Company Name	Daytime Phone#
Father's Occupation	Company Name	Daytime Phone#

YMCA Member? No Yes - YMCA Card#

Name of YMCA:

*How did you hear about Camp Pinewood?

Recruited by:

Period	Dates Duration	Session Cost	To Be Charged
Please check session(s) desired
2008 Leadership camps
Leader in training Waiting List	June 22-27	$575	$
Leader in training Waiting List	July 13-July 18	$575	$
Total			$
Discounts: Will be applied when verified $25 for recruiting a new camper (non-sibling) who lists you as the Recruiter on their application $50 YMCA metro Chicago members $25 per sibling registered $50 for multiple sessions (discount applied to 2nd session)

Transportation

Transportation by air-conditioned bus is available from the Metropolitan Chicago area, northwest Indiana, and southeast Michigan.

The cost is $65 per camper one-way, $95 per camper roundtrip.

If you wish either one-way or roundtrip transportation for this camper, check below and select the pick-up/drop-off location.

If you choose to drop-off or pick-up your camper, click for directions.

Select Transportation

To Camp: Driving Bus

From Camp: Driving Bus

Select Bus Stop:
Des Plaines YMCA Rolling Meadows, Holiday Inn Downers Grove YMCA Matteson, Holiday Inn Northbrook YMCA Oak Park YMCA	Irving Park YMCA Mich. City, IN Holiday Inn South Side YMCA Livonia, MI Holiday Inn
Transportation Total: $

Release

PLEASE NOTE:

A MINIMUM $100 DEPOSIT IS REQUIRED TO RESERVE EACH PERIOD AND MUST ACCOMPANY THIS APPLICATION. There will be no refunds when a child goes home early in case of disciplinary action. We or I (parents) approve this application and certify that our child is in good health. Acceptance of this application is contingent upon the camper passing a physical exam by the family physician within one year before leaving for camp.

The YMCA does not furnish accident/illness medical insurance. Medical bills, including prescription drugs, will be the responsibility of the parents. YMCA Camp Pinewood has my permission to use any photographs taken of my child in its annual camp promotion. In the event I cannot be reached in an EMERGENCY, I do hereby give my permission to transfer child named above off the camp property for the purpose of medical care or program activities as deemed appropriate by the Director. I hereby give my permission to the physician selected by the Camp Director, to hospitalize, secure proper treatment for, and to order injection, anesthesia or surgery for my child as named above. We or I (parents) have read and agree to all the conditions of this application.

I (We) Agree and submit registration

Payment

Total Amount: $ Minimum Deposit is $100 per session.
You may pay in full or pay a deposit of $ .
Charge it I prefer to call in my credit card information or mail a check.

Credit Card Information

Credit card:
Card number: Expiration: /
Note: This is NOT a secure site. If you're concerned about sending credit card information, 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