YMCA Camp Pinewood "Magic Steps to Growth"

2009 Mini Summer Camp Registration

Fill out this form to register for a 2009 mini-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 at (231) 821-0487

Registration forms received before January 31st, 2009 will receive a $25 discount for mini-camp.
*This and the Y Member discount will be the only available discounts for 2009*

Please visit the camps page on our website for more information on any of our programs.

Camper Information
*Camper's Full Name:
*Campers Gender:	Male Female
*Age at Camp(Ages 5-10 ):
*Camper's Birthday:	mm/dd/yy
*Home Phone Number:
*Camper's Address:
*City:	State: Zipcode:
One Cabin Mate Request We will do our best to honor all requests	(Within one year of each other.)
This is the Camper's	year at camp
Parents/Guardians Information
Parent/Guardian #1
*Parent/Guardian Name:
*Relationship to Camper: (Mother, Father,Guardian,Other)
Address (if different from camper):
City:	State: ZIP code:
*Daytime Phone:
Cell Phone:
E-Mail Address:
Parent/Guardian #2
Parent/Guardian Name:
Relationship to Camper: (Mother, Father,Guardian,Other)
Address (if different from camper):
City:	State: ZIP code:
Daytime Phone:
Cell Phone:
E-Mail Address:
Emergency Contact Information
*Emergency Contact Name:
*Relationship to Camper (Mother, Father, Other):
*Emergency Phone #1:
Emergency Phone #2:

YMCA of Metro Chicago Member? No Yes - YMCA Card#

If "Yes", which YMCA:

All YMCA of Metro Chicago members will receive a $25 discount

*How did you hear about Camp Pinewood?
or

Pioneer Unit (Ages 5 – 10)

2009 Mini Summer Camp Sessions
Select Session(s)	Dates	Availability	Price	Total
Session 1M (4 days)	June 14 - June 17		$375	$
Session 5M (4 days)	August 2 - August 5		$375	$
Mini Camp Total				$

Transportation

Transportation by air conditioned bus is available from the metropolitan Chicago area and southeast Michigan.
The cost is $65 per camper one-way, $95 per camper roundtrip.

YMCA Camp Pinewood reserves the right to change or cancel bus stops due to low enrollment from that location.

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:

I will be driving my camper
We will be using the bus service

Select Transportation From Camp:

I will be driving my camper
We will be using the bus service

If you will be using the Bus Service, please select a location:
Lattof YMCA – Des Plaines, IL Indian Boundary YMCA – Downers Grove, IL North Suburban YMCA – Northbook, IL	Irving Park YMCA – Chicago, IL West Cook YMCA – Oak Park, IL South Side YMCA – Chicago, IL
Transportation Total: $

Desposit/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 after June 1st are required to pay the remaining balance 2 weeks prior to the beginning of the session. Registrations received within 2 weeks of the beginning of the session are required to pay the full fee at that time. Final payments are due by June 1, 2009.

** 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