YMCA London Lightning Basketball Camp St. Thomas

LONDON LIGHTNING BASKETBALL
CAMP REGISTRATION
Family YMCA of
St. Thomas-Elgin
CAMPER INFORMATION
Name: Birthday: Address: City: Age at camp: Postal Code:
Gender:
m Male
m Female
Home Phone Number:
Session: mAM (9:00am - 12:00pm) - 7-12 years old mPM (1:00pm - 4:00pm) - 13-17 years old Tshirt: Youth mS mM mL or Adult mS mM mL
YMCA
London Lightning
PARENT 1/PRIMARY CONTACT Name: Home/Cell Phone: Work Phone:
Address: (if different than camper)
Basketball Camp
St. Thomas - July 21 - 25, 2014
Email: CUSTODY OF CAMPER
Please Specify:
m Mother Only
m Father Only m Both m Other:
I understand and permit pictures of my child to be taken at camp and used for promotional purposes for the YMCA of Western Ontario mYes mNo
#1 EMERGENCY CONTACT/AUTHORIZED PICK UP
Name: (other than parent) Relationship to camper:
*MANDATORY*
#2 EMERGENCY CONTACT/AUTHORIZED PICK UP
Home Phone:
Name: (other than parent) Home Phone:
Work/Cell Phone:
Relationship to camper: Work/Cell Phone:
MEDICAL INFORMATION
Does your child have any of the following?
m ADD
m ADHD
m OCD
Please list any medical or dietary conditions we should be aware of:
Please list any medications that your child requires while at camp: ASSISTANCE / PAYING FOR CAMP
Please list your monthly income (net, after taxes/deductions) _________________. Please send proof of income with your completed registration form.
If you wish to pay for camp please check here m $100/members, $140/non members. Payment can be made in the branch or send a cheque with your
registration form. Please make cheques out to YMCA of Western Ontario.
Participants will receive confirmation via phone/email within 2 weeks of registration form being recieved.
I permit my child noted above to attend camp at the YMCA of Western Ontario. I permit my child to participate in the full range of camp activities and authorize
the YMCA in the event of an accident or illness affecting the above child to authorize on my behalf all procedures including admission to the hospital and
necessary treatment therein, as she/he may deem essential for the care and well-being of said camper. Such action is to be taken only when immediate contact
with the undersigned cannot be made.
Signature of Parent/Guardian:
Date Signed:
ymcawo.ca
Why Y Day Camp?
Experiences that last a lifetime
YMCA day camp is the best way to
play, build relationships and start to
develop a healthy lifestyle like no other
day camp in London. For one week
only, we are offering London’s first
YMCA London Lightning Basketball
Camp for campers age 7-17 years old.
Get a chance of a lifetime and take part
by being on the court, doing drills,
workouts and participating with
NBA Superstars.
For five thrilling days, you’ll enjoy the
excitement of learning basketball skills
and being coached by by some of your
favorite London Lightning players!
Assisting with instruction and
motivation will be surprise teammates
from the London Lightning who will
help you to develop teambuilding and
leadership skills.
Commitment to Safety
All YMCA day camp sites are accredited
by the Ontario Camping Association
and are registered with High Five, a
quality standard for children’s sports
and recreation. We meet or exceed
industry standards and continually
audit our programs to ensure we’re
staying on top of health and safety.
Along with having fun and learning
new skills, campers will be supervised
and supported by caring YMCA staff.
Age Groups:
Boys and Girls 7-17 years of age
Session:
July 21-25, 2014
9:00am– 12:00am: 7-12 years of age
1:00pm – 4:00pm: 13-17 years of age
Location:
Family YMCA of St. Thomas-Elgin, 20 High
Street, St. Thomas, Ontario
Fee:
There is no charge for eligible participants.
You will be asked for financial information in
order to prove eligibility for funding to attend
camp.
Registration Options:
Please complete the attached registration
form (back cover) by June 27, 2014
Complete and submit form Attn: Richard
Broer
Fax: Complete you form and fax it into us at
519-631-4131
Please call us with any questions, concerns, or
help with your registration form:
519-631-2418 x227 or
rbroer@ymcawo.ca