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YMCA of Greater Vancouver
Camp Deka Registration 2010

If you do not want to fill out this form, please return to the previous page.

Here's How You Can Register:

Step 1: From lists below, select camp, program and session(s) desired and click to highlight.
Step 2: Complete Camper Information section. Required information is marked with a *.
Step 3: Complete Preliminary Medical Information and Camper / Parent Commitment sections.
Required information is marked with a *.
Step 4: Complete Payment Information section. Required information is marked with a *.
Step 5: Ensure all required information is correct and complete, and click on Submit Registration. You should see either a Form Complete page or a page asking you to enter information you might have missed. Incomplete forms will not be processed: one form per camper please. Payment will not be processed until space is confirmed. If a camp is full, you will be placed on the waiting list.
Thank you from YMCA-YWCA of Kamloops.

Camp Deka

* One-Week Programs

Note: tax, transportation and t-shirt are included in camp fees.

Transportation:
I require transportation from Downtown Kamloops YMCA-YWCA to Camp Deka
I require transportation from Camp Deka to Downtown Kamloops YMCA-YWCA

Camp T-Shirt:
Adult or Youth: Adult Youth Size: Small Medium Large
Registration form must be received by June 1st to guarantee your size.

Camper Information

(Required fields are marked with *)

* First Name
* Last Name / Family Name
* Birthdate  yyyy mm dd
Age (as of Dec 31, 2010)
* Male Female
* Street Address
* City
* Province
* Postal Code
* Phone (include Area Code)
* Contact
E-Mail
Swimming Ability
Poor Good Excellent
Cabin Mate Request
Parent 1 / Guardian 1
* Name
* Day Phone
Evening Phone
Parent 2 / Guardian 2
Name
Day Phone
Evening Phone
Alternate Emergency Contact
* Name
* Phone
* Custody
Mother Father Both Other
Who can pick up your child?
Who should not be contacting, visiting or picking up your child?


Preliminary Medical Information

(We will ask you for a follow-up form closer to the date of camp, in order to update these items.)

Medical Information

*
 		 Health Care Number
 
 		  
* Does your child require special medical attention? Yes No
If yes, provide details:
 
 
* Does your child have difficulties which may require some program adaptations? Yes No
If yes, provide details:
 
 
I require a consultation with the camp director regarding elements
of my child's participation. 		Yes No
Is there anything we need to know to ensure a positive camp experience for your child?
(i.e. Night Terrors, Sleepwalking, Bedwetting, Homesickness, ADD, etc)


 

Allergies

*
 		 My child is allergic to
If your child has no allergies please indicate ‘not applicable’.
Mild Moderate Severe
Treatment / Comments:
Additional Information:
  Dietary Requirements:
 
 

Camper's Commitment

  I want to become a camper at Camp Deka. I agree to abide by the camp rules. I will do my best to make this a good experience for myself and my fellow camper. I understand that failure to live up to this promise might result in my dismissal from camp.
* Camper's Name in lieu of signature:
* Name of Parent/Guardian in lieu of signature:

Parent's Commitment

  I have discussed the Camper's and Parent's Commitment with my child and confirm that this camper agrees to participate in the full program, to follow safety instructions and/or refrain from behavior that is harmful to oneself or others. I understand and support the camp policy that prohibits the possession or use of tobacco, alcohol or non-prescription drugs and understand their use as well as abusive behavior is cause for dismissal without refund of camp fees.
* Date:
* Name of Parent/Guardian in lieu of signature:

Photo Release

  I authorize the Y to use any photos of my child obtained while engaged in Y Camps programs for promotional purposes.
* Date:
* Name of Parent/Guardian in lieu of signature:

Authorization

  In permitting my child to attend Camp Deka, I, the undersigned permit my child to participate in the full range of camp activities and authorize the Camp Director or his/her appointee, in the event of accident or illness affecting this above named camper to authorize on my behalf all procedures, including admission to hospital and necessary treatment therein, as he/she may deem essential for the care and well-being of the camper. Such action is only to be taken when immediate contact with the undersigned cannot be made. It is understood that the Camp is not responsible for Medical Care Cost.
* Date:
* Name of Parent/Guardian in lieu of signature:


Payment Information (taxes included)

Full payment or a $100 deposit per child per camp and post dated payments is required. FINAL PAYMENT must be dated no later than 4 weeks prior to session start date. Payment for online registrations must be made with VISA, MasterCard or AMEX. Other payment options (Cash/ Interac) are available - please contact our office (250-372-7725) for information on these. Financial assistance is available for YMCA Camp experiences.
Base Fee $ 
Less Deposit - $ 
Balance = $ 

  Payment Method:
* Visa Mastercard AMEX
* Card #
* Expiry Date (mm/yy)
* Name of Cardholder

Dates & amounts to charge credit card:
Date Amount


Authorization

By submitting this form, I authorize the Kamloops YMCA-YWCA to process the above payment(s) to be applied to Kamloops YMCA-YWCA camping programs. I have read and understand the refund policy and payment plans.

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