Camp Jewell YMCA 2010 Registration Form

 
CAMPER'S INFORMATION
* Camper Last Name
* Camper First Name
 
FATHER'S INFORMATION
Father's Last Name
Father's First Name
Father's Home Phone
Father's Work Phone
Father's Cell Phone/Pager
Father's Email Address
Camp Jewell YMCA Alumni? Yes No
Father's Occupation
 
MOTHER'S INFORMATION
Mother's Last Name
Mother's First Name
Mother's Home Phone
Mother's Work Phone
Mother's Cell Phone/Pager
Mother's Email Address
Camp Jewell YMCA Alumni? Yes No
Mother's Occupation
 
CAMPER'S INFORMATION CONTINUED
* Camper Address
* City
* State
* Zip
 
ADDITIONAL EMERGENCY CONTACT
* Emergency Contact Full Name
* Emergency Contact Relationship
* Emergency Contact Home Phone
* Emergency Contact Work Phone
 
CAMPER'S INFORMATION CONTINUED
* Date of Birth
* Age while at camp
* Gender
* Grade, Fall 2010
* School
Camper’s Email Address
TOP/BOTTOM BUNK PREFERENCE (RESIDENT CAMP ONLY)
If available, I prefer the top bunk
bottom bunk
* With whom does the camper live

Each Resident camper is provided a free T-shirt on check-in day.

Please indicate your child’s size
Resident Camp Only		 YS
YM
YL
AS
AM
AL
* This will be my ___ year at Camp Jewell YMCA
* How did you hear about Camp Jewell YMCA
CABIN MATE REQUEST (RESIDENT CAMP ONLY)
(only one name will be guaranteed)
 
PLEASE CHECK SESSION(S) DESIRED

Tier Pricing Program

Realizing that families have differing abilities to pay, Camp Jewell YMCA has instituted a voluntary 4-tier pricing program for our Summer Resident Camp. Please take a moment to look at the tier descriptions and choose the tier that is most suitable for your family. All children will have the same experience no matter which tier a family is able to pay. The tier selected by a family will be kept confidential.

Tier 1

This price more accurately accounts for true costs of operating, including, but not limited to: general overhead, transportation, marketing, capital improvements and depreciation.

Tier 2

This price more accurately accounts for some additional costs of operating, including wear and tear on equipment, and the purchasing of new equipment.

Tier 3

This price more accurately accounts for the basic costs of attending camp, including food, staff salaries and supplies.

Tier 4

This is a variable rate, made possible by donations to the YMCA’s Strong Kids Annual Campaign, for families who have need for financial assistance. To apply, please request a financial assistance application form from the YMCA.


Horsemanship lessons during day camp and traditional resident camp are $75 for 4 lessons


TRADITIONAL ONE-WEEK CAMP (AGE 7-9)
Traditional One-Week CampDateTier 1Tier 2Tier 3Tier 4
Session 1A6/27-7/3  $925   $825   $725   FA*  Horse
Session 1B7/4-7/10  $925   $825   $725   FA*  Horse
Session 2A7/11-7/17  $925   $825   $725   FA*  Horse
Session 2B7/18-7/24  $925   $825   $725   FA*  Horse
Session 3A7/25-7/31  $925   $825   $725   FA*  Horse
Session 3B8/1-8/7  $925   $825   $725   FA*  Horse
Session 4A8/8-8/14  $925   $825   $725   FA*  Horse
Session 4B8/15-8/21  $925   $825   $725   FA*  Horse
TRADITIONAL TWO-WEEK CAMP (AGE 10-14)
Traditional Two-Week CampDateTier 1Tier 2Tier 3Tier 4
Session 16/27-7/10  $1,645   $1,545   $1,445   FA*  Horse
Session 27/11-7/24  $1,645   $1,545   $1,445   FA*  Horse
Session 37/25-8/7  $1,645   $1,545   $1,445   FA*  Horse
Session 48/8-8/21  $1,645   $1,545   $1,445   FA*  Horse
LIT PROGRAM I (AGE 15)
LIT Program IDateTier 1Tier 2Tier 3Tier 4
Session L16/27-7/10  $1,645   $1,545   $1,445   FA* 
Session L27/11-7/24  $1,645   $1,545   $1,445   FA* 
Session L37/25-8/7  $1,645   $1,545   $1,445   FA* 
Session L48/8-8/21  $1,645   $1,545   $1,445   FA* 
LIT PROGRAM II (AGE 15)
LIT Program IIDateTier 1Tier 2Tier 3Tier 4
Session L2-17/11-7/24  $1,645   $1,545   $1,445   FA* 
Session L2-28/8-8/21  $1,645   $1,545   $1,445   FA* 
CIT PROGRAM (AGE 16)
CIT ProgramDateTier 1Tier 2Tier 3Tier 4
Session C16/27-7/24  $1,645   $1,545   $1,445   FA* 
Session C27/25-8/21  $1,645   $1,545   $1,445   FA* 
JUNIOR RANCH CAMP (AGE 7-9)
Junior Ranch CampDateTier 1Tier 2Tier 3Tier 4
Session J17/4-7/10  $1,125   $1,025   $925   FA* 
Session J28/8-8/14  $1,125   $1,025   $925   FA* 
DRIVERS ONE-WEEK RANCH CAMP (AGE 10-12)
Drivers One-Week Ranch CampDateTier 1Tier 2Tier 3Tier 4
Session 1A6/27-7/3  $1,125   $1,025   $925   FA* 
Session 1B7/4-7/10  $1,125   $1,025   $925   FA* 
Session 2A7/11-7/17  $1,125   $1,025   $925   FA* 
Session 2B7/18-7/24  $1,125   $1,025   $925   FA* 
Session 3A7/25-7/31  $1,125   $1,025   $925   FA* 
Session 3B8/1-8/7  $1,125   $1,025   $925   FA* 
Session 4A8/8-8/14  $1,125   $1,025   $925   FA* 
Session 4B8/15-8/21  $1,125   $1,025   $925   FA* 
TOP-HANDS TWO-WEEK RANCH CAMP (AGE 12-15)
Top-Hands Two-Week Ranch CampDateTier 1Tier 2Tier 3Tier 4
Session 16/27-7/10  $2,045   $1,945   $1,845   FA* 
Session 27/11-7/24  $2,045   $1,945   $1,845   FA* 
Session 37/25-8/7  $2,045   $1,945   $1,845   FA* 
Session 48/8-8/21  $2,045   $1,945   $1,845   FA* 
MAINE HORSEPACK TRIP (AGE 12-15)
Maine Horsepack TripDateTier 1Tier 2Tier 3Tier 4
Session 37/25-8/7  $2,695   $2,595   $2,495   FA* 
Session 48/8–8/21  $2,695   $2,595   $2,495   FA* 
MAVERICK PROGRAM (AGE 16)
Maverick ProgramDateTier 1Tier 2Tier 3Tier 4
Session C16/27-7/24  $1,645   $1,545   $1,445   FA* 
Session C27/25-8/21  $1,645   $1,545   $1,445   FA* 
ADVENTURE TRIPS ONE-WEEK PROGRAM (AGE 13-17)
Adventure Trips One-Week ProgramDateTier 1Tier 2Tier 3Tier 4
Maine Rafting & Climbing6/27-7/3  $1,125   $1,025   $925   FA* 
Lake George Sailing7/4-7/10  $1,125   $1,025   $925   FA* 
Cape Cod Bike 17/11-7/17  $1,125   $1,025   $925   FA* 
Mystery Machine7/18-7/24  $1,125   $1,025   $925   FA* 
Acadia Sea Kayak & Climb7/25-7/31  $1,125   $1,025   $925   FA* 
Cape Cod Bike 28/1-8/7  $1,125   $1,025   $925   FA* 
Cape Cod Bike 38/8-8/14  $1,125   $1,025   $925   FA* 
5 States in 7 Days8/15-8/21  $1,125   $1,025   $925   FA* 
DAY CAMP (AGE 4-14)
Day CampDatePricePre-CampPost-CampHorsemanship
Session A6/28-7/2  $175   $12   $12   $75 
Session B7/5–7/9  $175   $12   $12   $75 
Session C7/12-7/16  $175   $12   $12   $75 
Session D7/19-7/23  $175   $12   $12   $75 
Session E7/26-7/30  $175   $12   $12   $75 
Session F8/2-8/6  $175   $12   $12   $75 
Session G8/9-8/13  $175   $12   $12   $75 
Session H8/16-8/20  $175   $12   $12   $75 

Pre-Camp: $12 one time fee per session
Post-Camp: $12 one time fee per session


HOLDOVER WEEKENDS BETWEEN SESSIONS $75 (RESIDENT CAMPS ONLY)
  • July 3-4
  • July 10-11
  • July 17-18
  • July 24-25
  • July 31 - August 1
  • August 7-8
  • August 14-15

* Please mail me a financial assistance application
A $200 non-refundable/non-transferable deposit is required for each resident camp session.
A $50 non-refundable/non-transferable deposit is required for each day camp session.
The YMCA strives to serve all people regardless of ability to pay.
Financial assistance information is available at our office. (888) 412-2267
All programs are open to everyone, without regard to race, sex, color, religion or national origin.
 
IMPORTANT
If session(s) I have requested above are full, my second choice would be
 
CAMPER'S COMMITMENT

* I want to become a camper at Camp Jewell YMCA. If accepted I agree to abide by the camp's code of conduct and camp rules. I will do my best to make this a good experience for myself and my fellow campers. I understand that failure to live up to this promise might result in my dismissal from camp. (Without a refund.)

* Campers Agreement Please write camper name
Today's Date
 
PARENT/GUARDIAN AGREEMENT

* I approve this application, and certify that the proposed camper is capable of such an experience. I agree to have a health form signed by a physician or his designee that includes current medication orders and physical exam. This exam must have been given within 24 months of the camper's arrival date and brought to camp on check-in day. A downloadable health form can be found on camp’s website.

* Parent/Guardian Agreement 1 Please write parent/guardian name

The YMCA is a membership organization. Camper's membership fee is included within each session's fees.

* I agree to pay 50 percent of the balance by March 1st and the balance in full by May 1st. Cancellations after March 1st are eligible for only a 50% refund of total session fees paid. Cancellations after May 1st are not eligible for any refund. Refunds will be considered only after a written request. Only in case of illness, not homesickness, will any refund be made and then only on a pro-rated basis.

* I hereby grant permission for the applicant to participate in all planned camp activities and programs including out-of-camp trips by camp vehicle, biking, horseback, or hiking, understanding that competent leadership will be provided. I authorize the Camp Director and Camp Nurse to seek emergency medical attention for my child in the case of accident or illness if I cannot be reached by phone. I authorize the YMCA to have and use the name, photographs, slides, and video tape of the person named on this application in camp promotional materials. I understand that cabin mate requests are only granted if both campers of similar age request each other.

* Parent/Guardian Agreement 2 Please write parent/guardian name
 
AMERICAN EXPRESS/DISCOVER/MASTERCARD/VISA AUTHORIZATION
To secure a reservation, you must make a minimum payment of $0 (this is the total deposit amount per child per session)
* Please charge $ to my
* Card #
* Security Code
  (typically 3 or 4 digit code on the reverse side of credit cards)
* Expiration Date
* Cardholders name
* Initials of Authorized User
* Charge Date
My child's total fee(s) (include registration fee): $ 0
My child's total non-refundable deposit per 0 session(s): $ 0
Click here to get your child excited about their upcoming camp experience with an official Camp Jewell Welcome Kit! The kit includes a water bottle, flashlight, welcome letter and 4-5 other items from our camp store. The cost is $30 per kit and includes shipping and handling. The kit is mailed out upon reservation confirmation.

Please send me information about Family Camp and other year-round programs at Camp Jewell

I would like to give $ ____ to the Strong Kids Campership Campaign
for financially disadvantaged children

I would like to receive information about becoming an international host
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