Summer Program Guide 2016 EMBARCADERO YMCA

BEST
SUMMER
EVER
Summer Program Guide 2016
EMBARCADERO YMCA
BEST SUMMER EVER
At the Y, we have fun for everyone this summer, regardless of your age, income, or
background. We bring people closer together in a welcoming and supportive environment to
nurture the potential of youth, promote healthy living, and give back to the community.
This summer, children can learn, grow, and thrive through the exhilarating fun
of sports, day, and specialty camps at the Y. In the midst of all the fun, they will
explore nature, find new talents, try new activities, gain independence, and make
lasting friendships.
Teens can have fun socializing with their friends in a safe and positive environment, while
exploring their interests, learning leadership skills, and discovering all they can achieve.
Adults can experience the fun of connecting with people from all walks of life through
programs and services at the Y that go beyond just physical health.
Plan your summer fun at the Y, and experience the impact we can make in your
life and your community.
2 EMBARCADERO YMCA
Join the Y today.
Financial Assistance Available
WHO WE ARE
The Y is the nation’s leading nonprofit committed to
strengthening communities through youth development,
healthy living, and social responsibility.
HOW WE DO IT
We integrate our four core values of caring, honesty, respect,
and responsibility in everything we do. We create extraordinary
memories through providing opportunities to engage in new,
fun, and enriching experiences.
At the Y, we help kids develop new skills and interests, interact
in positive ways, and engage in healthy lifestyles, while being
mentored by positive adult role models.
OUR IMPACT
The Y is, and always will be, dedicated to building healthy,
confident, connected, and secure children, adults, families, and
communities. Every day our impact is felt when an individual
makes a healthy choice, when a mentor inspires a child, and
when a community comes together for the common good.
FACILITY MEMBERSHIP BENEFITS
Membership privileges include access to our
entire facility and complimentary Wellness Coaching.
WEBSITE
www.ymcasf.org/embarcadero
FACILITY HOURS OF OPERATION
Monday–Friday 5:30AM – 9:45PM
Saturday8:00AM – 7:45PM
Sunday9:00AM – 5:45PM
TABLE OF CONTENTS
Summer Camp For Everyone...............2-3
About Y Camp........................................ 4
Camp and Registration.......................... 5
Payment and Camp Schedules............... 5
Policies and FAQS.................................. 6
Typical Camp Schedule.......................... 7
Day Camps.........................................8-9
Swim, Sports & Play..............................10
Summer Camp Planner..........................11
3 EMBARCADERO YMCA
CAMP HOURS
Drop-off 7:30AM –9:30AM
Camp Program 9:30AM –4:30PM
Pick-up4:30PM –6:00PM
BRANCH INFORMATION
EMBARCADERO YMCA
169 Steuart Street
San Francisco, CA 94105
Phone: (415) 957-9622 Fax: (415) 957-1260
CAMP CONTACTS
Shiante Lewis
Community Programs Director
(415) 615-1304
slewis@ymcasf.org
For Billing Questions:
Sarah Millett
Community Programs Administrative Services Specialist
(415) 615-1315
smillett@ymcasf.org
ABOUT Y CAMP
WHAT IS Y CAMP?
At the YMCA of San Francisco, we strive to provide a wellrounded program to support the learning and growth of every
camper. We are providing the essential features of the Y Camp
experience which are the following elements:
• Culture • Safety • Values • Fun • Relationships • Exploration
• Leadership • Good quality staff • Skills building • Community
WHY YOUR CHILD BELONGS AT YMCA SUMMER CAMP...
Our camp experience
With more than 100 years of Summer Camp, the Y knows
how to make a safe and nurturing place, where children build
self-esteem, leadership skills, and a sense of responsibility for
themselves and the world around them.
Our commitment
Your child will find the confidence for creative self-expression
through songs, art, new friendships, and new adventures. We
offer more than non-stop fun. Your child will learn how to apply
time, talent, and energy toward a caring, honest, respectful,
and responsible life.
Our leaders
Each summer our camp staff completes over 80 hours of summer
camp training. We are caring, competent, and experienced. Our
training includes camp safety, activity planning, CPR, and First Aid
to make your child’s experience both safe and fun.
Our pledge
We are dedicated to making you and your child’s experiences at
YMCA camp extraordinary.
THINGS WE VALUE AT CAMP
Summer Learning
• Intentional Programing
• Outcome-based activities
• Learning objectives and reflections
• Physical activates to stimulate learning
• Thematic based learning
Safety First
• Low staff-to-camper ratio
• Campers are assigned to a specific leader within the camp
• Monitored sign-in/sign-out
• Staff training
• High Safety standards
• Fully certified charter bus drivers
Fun, Values-based Activities
• Variety of outdoor activities
• Field trips
• Swimming and water activities
• Hands-on environmental experiences
• Multicultural activities
• Service learning projects
• Special events
• Positive adult role models
Parent Communication
• You will receive weekly highlight sheets with activity
schedules and special reminders.
• You can communicate with our staff to help your
child have a great experience.
• Our staff will inform you of your child’s successes
and challenges.
• We will conduct weekly evaluations for feedback.
• The Camp Director is available by phone or email.
• We keep your personal information confidential.
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CAMP REGISTRATION
PAYMENT INFO
HOW TO CREATE YOUR ONLINE MEMBER PROFILE
Set up your online membership profile today. Then you’ll be
ready to register online!
1. Go to http://www.ymcasf.org and click on the “REGISTER
ONLINE” tab at the top right of the screen. (for returning
members only)
2. Click on the “Login” link above the “Search for programs by
keyword” box.
3. Click on the “Find Account” link, located in the “I want to set
up online access for my account” box.
4. Enter the required personal information when prompted.
5. Enter the e-mail address associated with your membership
account (a link will be sent to this e-mail).
6. Once e-mail is received, follow the “Reset password” link and
choose a password for your DAXKO account. Repeat steps
1,2,3 and sign in using the “I want to sign into my account”
box.
SUMMER CAMP REGISTRATION
Please complete all information, including camper and parent/
guardian names, birth dates, and contact information. Also
include any medical or behavior information that we may need
to know to ensure that your camper has the best experience.
CREDIT/REFUND POLICIES
Deposits are non-refundable and non-transferable. No credits,
refunds, or transfers are allowed within 14 days of the start of
program for which you are registering. If you wish to make a
change or cancel your registration prior to the 14-day deadline,
you may choose one of the following:
SPECIAL RATE REDUCTIONS
Corporate Partners Special: $10 off per family / per week.
Sibling Special: First child is full-price. Each subsequent child
will receive $10 off per week.
Please note:
• Special rates can only be applied to registrations done
in-person.
• Special rates cannot be combined with each other, or any
other special offers.
Register onine at:
www.ymcasf.org/embarcadero
Or register in person at our Member Services desk
5 EMBARCADERO YMCA
• Transfer to another Embarcadero YMCA camp program minus
the deposit (registration must be available).
• A check or credit card refund (minus the non-refundable
deposit). Check refunds can only be issued for amounts over
$20. Please allow two weeks for processing.
• All cancelations must be submitted in writing. Please contact
Sarah Millett at smillett@ymcasf.org, or call (415) 615-1315
for further details.
Before camp starts, we pay our vendors, purchase our
admission tickets and supplies, and hire our staff according
to the enrollment. Our policies have been created with these
expenses in mind.
FINANCIAL ASSISTANCE
We strive to make Y Camp accessible to all. To the extent
possible, financial assistance is available thanks to the
generous donors who contribute to our Annual Giving
Campaign. Financial assistance forms are available online and
at the membership desk. Please submit forms in person, or via
email to Sarah Millett at smillett@ymcasf.org or drop them off
at Member Services. Camp financial assistance applications
must be submitted by May 1, 2016. You will be notified by May
18, 2016, regarding your application. Space is limited and spots
will not be held unless a deposit is provided.
PAYMENT DUE DATES
CAMP
SESSION
CAMP
DATES
PAYMENT
DUE
WEEK 1
May 31-June 3
May 17
WEEK 2
June 6-10
May 23
WEEK 3
June 13-17
May 30
WEEK 4
June 20-24
June 6
WEEK 5
June 27-July 1
June 13
WEEK 6
July 5-8
June 21
WEEK 7
July 11-15
June 27
WEEK 8
July 18-22
July 4
WEEK 9
July 25-29
July 11
WEEK 10
August 1-5
July 18
WEEK 11
August 8-12
July 25
GENERAL INFO & FAQ’S
GENERAL CAMP INFORMATION
FREQUENTLY ASKED QUESTIONS
Sign In/Out Procedure: Sign-in begins each day at 7:30am
and closes at 9:30am. Pick up begins at 4:30pm and ends at
6:00pm. Every day your child must be signed in and out by
an adult listed on the registration form. To add an adult to
your child’s pick up list, you must contact your camper’s unit
director. Anyone picking a child up is required to show a picture
ID to a Member Services staff person every time they enter
the Y. If you need to pick up your child prior to the authorized
times you will need to connect directly with your child’s unit
director.
What should I bring to camp? For a typical day of camp, your
child will need the following items each day:
Absence: If your child will be absent, please email Shiante
Lewis, Community Programs Director at slewis@ymcasf.org or
call (415) 615-1304, with the date, child’s name, child’s camp,
parent’s name and phone number. We do not give refunds or
credits for missed days.
Illness: Please help us prevent and reduce the spread of illness
at Camp. Parents are required to notify the site if they or
their children contact a communicable disease and will not be
allowed to attend camp.
Discipline Policy: Please keep the staff informed of any issues
so that we can be sensitive to your child’s needs. We would like
to work as a team with your family for the betterment of your
child. This will enable us to provide the best environment for
your child’s growth and development.
Our first step is to be proactive in our approach towards
behavior management. We take steps before a situation
occurs. The more we know about a child’s home and school
life the easier it will be for us to take this step. We also use
positive reinforcement by consistently acknowledging good
behavior.
Parent Info Nights at the Embarcadero YMCA
169 Steuart Street, San Francisco 94105
Come meet your camp unit directors and management staff! We
will go over camp policies, procedures, and general questions
for the summer. You will only need to attend one night to get
all the information you need regarding your child’s fun filled
summer.
Parent Night #1
May 14, 2016 • 12:30-1:30pm
Parent Night #2
May 19, 2016 • 6:00-7:00pm
Parent Night #3
May 22, 2016 • 12:00-1:00pm
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• Backpack
• Water bottle
• Jacket or sweatshirt
• Healthy lunch
• Comfortable clothes and shoes
• A good attitude
What if I am late dropping off and picking up my child from
camp? Any time you are going to be late it is important for
you to call Member Services at (415) 957-9622 to inform
staff. If a camper is dropped off late and their camp has left
the Y, the parent is not permitted to leave their camper with
another camp group. The parent can chose to take their child
to the camp’s location. At the end of the day, if the parent is
repeatedly late picking up the child a charge of $1 per minute
will be billed to your account.
What if my child is a few months too young to attend camp?
Camps are organized by grades, not age. All campers must be
entering the grade in the fall as listed for each camp, unless
authorized by the Camp Director.
How do I ensure my camper is in the same group as his/her
friend? Camp is an important place to make new friends and
develop new relationships. We encourage parents to support
this goal. If you would like to ensure campers are within the
same group, you may provide a written note for the Unit
Director of your camp on the first day. Camp staff will attempt
to ensure your campers are in the same group, but groupings
depend on ability and/or age and these accommodations will
not always be possible.
Where do I turn in my medical release/liability waiver
form? Medical release/liability waiver forms are required for
each camper. All medical release/liability waiver forms may
be dropped off at the Member Services desk during regular
business hours or mailed to the Embarcadero YMCA, Attention:
Sarah Millett, 169 Steuart Street, San Francisco, CA 94105.
When is the balance due for camp? The deposit for each camp
is due at registration. The remaining balance for each camp
is due 14 days prior to the start date of camp. Failure to pay
balances will result in forfeiture of the deposit and registration.
TYPICAL CAMP
SCHEDULE
IN-HOUSE SCHEDULE
7:30am-9:30am Drop-off / Kids Choice
9:30am-10:00am Morning Assembly & Snack (Provided)
10:00am-11:00am Activity #1
11:00am-12:00pm Swim* or Group Games
12:00pm-1:00pm Community Circle & Lunch
1:00pm-2:00pm Activity #2
2:00pm-3:00pm Swim* or Group Games
3:00pm-4:00pm Activity #3
4:00pm-4:30pm Afternoon Assembly & Snack (Provided)
4:30pm-6:00pm Pick-up/Kids Choice
*Campers will swim once a week at the Embarcadero Y.
Camp swim can be before or after Lunch. Please bring swimsuit.
MAJOR, WATER PARK, AND
OUTDOOR ADVENTURE SCHEDULES
7:30am-9:30am: Drop-off / Kids Choice
9:30am-10:00am: Morning Assembly & Snack
10:00am-4:00pm: Trip of the day
4:00pm-4:30pm: Afternoon Assembly & Snack
4:30pm-6:00pm: Pick-up/ Kids Choice
*Lunch takes place between 12 and 1 o’clock each day.
Major Field Trips Days: Each major field trip is a fun filled
adventure tied to the weekly theme. Fostering excitement,
adventure and bonding, each camper is in for a treat!
Water Trips Days: Each water day campers will have the
opportunity to travel to the Bay Area’s lakes and waterparks
(age appropriate). Please send your camper with swimsuit
underneath their regular clothes and a towel on water days.
Park Days: Campers will have the opportunity to travel to
numerous San Francisco playgrounds throughout the summer.
Outdoor Adventure Days: Campers will have the opportunity
to hike, run, climb and play all throughout the Bay Area! Visiting
various trails, beaches and other outdoor locations; each
camper will have an opportunity to further their connection
with nature!
In-house Days: Campers will have the opportunity to take
advantage of our YMCA facility! Campers will utilize our pool,
gym, and other rooms for a day full of excitement!
REGISTER ONLINE
TODAY!
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INTERESTED IN
OVERNIGHT CAMP?
Spend a week at sleep-away camp in the Santa Cruz
Mountains. YMCA Camp Jones Gulch, with its acres of
redwoods, is the perfect summer getaway for youth
entering grades 1st-11th.
Camp offers horseback riding, swimming, crafts,
sports, climbing tower, canoeing, hiking, gardening
and more. The traditional campfires, camp songs, and
s’mores are all part of the fun as well!
Jones Gulch High Adventure Camp provides teens in
grades 6-12 with exciting opportunities in a variety
of activities as they travel together through some of
California’s most beautiful natural areas. They also
have family camps and user group facilities.
Call 650-747-1200 or visit Camp Jones Gulch
online at www.ymcasf.org/campjonesgulch.
DAY CAMPS
SPORTS & SPECIALTY CAMPS
At Embarcadero Day Camp, your child will experience
days full of games, swimming, arts and crafts, sports, and
opportunities to begin lifelong friendships! Our camp is
designed to keep campers engaged and moving throughout
the day. The YMCA prides itself on hiring quality staff to
take care of your child. Expect fun-filled days at camp with
endless opportunities to learn new skills, work on crafts,
and make new friends.
TRADITIONAL
Program Member: $265 per/week
Facility Member: $245 per/week
Daily: $100 Program / $80 Facility
* WEEK 6
No Camp July 4
Program Member: $212
Facility Member: $192
WEEK 1: Bay Area Adventurers
May 31 - June 3
WEEK 2: Time Travelers
June 6 - June 10
WEEK 3: Inventor’s Workshop June 13 - June 17
WEEK 4: Fun and Fitness
June 20 - June 24
WEEK 5: Creative Campers
June 27 - July 1
WEEK 6: Adventure Land July 5 - July 8
WEEK 7: Wet and Wild July 11 - July 15
WEEK 8: Outside the Box July 18 - July 22
WEEK 9: Camps Got Spirit
July 25 - July 29
WEEK 10: Where the Wild Things Are August 1 - August 5
WEEK 11: Dog Days of Summer August 8 - August 12
DISCOVERERS CAMP / GRADES ENTERING K-1 / RATIO 1:8
YMCA Discoverers Camp introduces young campers to the
excitement of day camp. This includes silly skits, arts & crafts,
laughter-inducing games, fun physical activities, open swim
once a week, and eye-opening field trips.
ADVENTURERS CAMP / GRADES ENTERING 2-3 / RATIO 1:8
YMCA Adventurers Camp gives campers an opportunity to build
friendships, explore new places, build new skills, and participate
in an open swim once a week.
EXPLORERS & MOVIN’ON CAMP
GRADES ENTERING 4-5 / RATIO 1:10
YMCA Explorers and YMCA Movin’ On campers will not only
experience fun off-site field trips, but they will also participate
in fun-filled activities to help build new relationships, develop
independence, and learn about the city in which they live.
SPORTS & SPECIALTY CAMPS
GRADES ENTERING K-5 / RATIO 1:8
YMCA Sports and Specialty Camps are designed to meet the
needs of campers who want to spend more time focusing on
one activity. Sports Camp will help develop your camper’s
athletic skills while reinforcing the fun of sports. Specialty
Camps will encourage campers to dig deep into the world of
science and engineering, while experiencing summer camp.
8 EMBARCADERO YMCA
Program Member: $330 per/week
Facility Member: $310 per/week
* WEEK 6
No Camp July 4
Program Member: $240
Facility Member: $210
WEEK 2: Soccer Camp June 6 - June 10
WEEK 3: Lego Camp
June 13 - June 17
WEEK 4: Baseball Camp
June 20 - June 24
WEEK 5: Lego Camp June 27 - July 1
WEEK 6: Basketball Camp
July 5 - July 8
WEEK 7: Soccer Camp
July 11 - July 15
WEEK 8: Star Wars Camp July 18 - July 22
WEEK 9: Lego Camp July 25 - July 29
WEEK 10: Multi-Sports Camp Aug 1 - Aug 5
BASKETBALL: Lace up your high-tops and show off old
tricks while learning new ones. Campers will improve their
fundamentals with fun drills and scrimmages all while learning
the importance of teamwork. All skill levels are welcome.
SOCCER: Kick off the summer right as your camper learns or
improves their fundamental soccer skills. Campers will develop
confidence and lasting team bonds during our week of fun drills
and scrimmages. All skill levels are welcome.
BASEBALL: Campers will hit, run, and score at our week-long
baseball camp. All skill levels will benefit from our activities,
drills, home run derbies and more.
LEGO Camp: Power up your engineering skills with over
100,000 pieces of LEGO! Apply real world concepts in physics,
engineering, and architecture through projects such as arch
bridges, skyscrapers, motorized cars, and the Battletrack!
Explore your craziest ideas in a supportive environment.
An experienced instructor will challenge new and returning
campers to build at the next level.
Star Wars Camp: Be a part of the action with clone wars
camp! We will spend a whole week learning about the Star Wars
universe, and the various aspects of it as they pertain to the
clone wars era, all while having a lot of fun activities associated
to aspects of the clone wars: hone light saber skills as we
explore what it is to be a Jedi, ready (simulated) blasters and
thermal detonators as we take on simulated battle droids as
the republic’s clone army, build flying devices, learn Jedi mind
tricks, and a whole lot more!
Multi-Sports Camp: Basketball, soccer, tennis, you name it, we
are doing it! Our days will be filled with drills, scrimmages, and
other games and team building activities. Campers will learn
good sportsmanship, the importance of teamwork, and develop
new skills from various sports .
DAY CAMPS
COUNSELOR IN TRAINING (CIT)
GRADES ENTERING 9-10
This skill-based training program prepares teens to work
as camp counselors, and to gain basic job skills. All new
CIT participants will need to attend a one-week training.
Pending their participation and interview, they can continue
attending camp doing CIT field work. During their training
session they will focus on camper development, communication, leadership, activity planning, and safety.
Training Sesson (Week 2) June 6 - June 10
Cost: Program Member$275.00 / Facility Member$255.00
Field Work Weeks ( Weeks 3-10) June 13 - Aug 12
Cost: Program Member$85.00 / Facility Member$75.00
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SWIM, SPORTS & PLAY
AQUATICS & YOUTH SPORTS PROGRAMS
Swimming is a life skill, as well as great
exercise and a challenging sport. The benefits
are far greater than just physical health.
Whether it’s learning the life skill of water
safety or gaining the confidence that comes
from learning to swim, participating in
aquatics programs at the Y is about building
the whole person, from the inside out.
CAMP SWIM LESSONS
Day Camp swim lessons will be offered in one-week
sessions (Monday through Friday) in conjunction
with camp sessions. Lessons will be offered at two
different times in the morning-8:00am and 8:40am.
Each session lasts 30 minutes. All children must arrive
20 minutes before the lesson begins to change clothes.
We do not provide goggles or plastic bags. Please bring
goggles and a bag that your child can keep their wet
belongings in. Write your camper’s name on all items
that they bring.
FEE
FACILITY MEMBER PROGRAM MEMBER*
$75/week (5 lessons)
$95/week (5 lessons)
WEEKEND SWIM LESSONS
We also offer swim lessons on Saturday & Sunday mornings
throughout the year for children 6 months -14 years old. They
are broken down by age and skill level for kids to enjoy their
lessons and progression. See the youth lesson flyer for more
informtion. Advanced classes are 40 minutes long, all other
classes are 30 minutes long.
SESSION 2: March 19 - May 15 (no classes 3/26-27)
SESSION 3: June 4 - July 31 (no classes 7/2, 7/3, & 7/4)
SESSION 4: August 13 - October 9 (no classes 9/3-4)
SESSION 5: October 22 - December 18 (no classes 11/26-27)
*Each session has eight classes
FEE
30 minutes
40 minutes
FACILITY MEMBER
$90 (8 lessons)
$100 (8 lessons)
PROGRAM MEMBER*
$115 (8 lessons)
$125 (8 sessions)
* A current Program Membership ($50) is required at registration
CONTACT:
Jimmy Beckland, Aquatics Director
Phone: (415) 615-1326 / Email: jbeckland@ymcasf.org
10 EMBARCADERO YMCA
INVENTOR’S
WORKSHOP
TIME
TRAVELERS
BAY AREA
ADVENTURES
FUN AND
FITNESS
June
20-24
WEEK 4
CREATIVE
CAMPERS
June 27July 1
WEEK 5
Fairy Land
Creativity
Museum
Super Franks
Bay Area
Discovery
Museum
The Jungle
San Jose
Discovery
Museum
Pump it Up SF
Nickle City
San Jose Tech
Museum
Sports Plex
Nickle City
San Jose Tech
Museum
Sports Plex
Exploratorium
Exploratorium
Creativity
Museum
Golf Land
Golf Land
Adventure
Playground
Happy
Hallows
ADVENTURE
LAND
July
5-8
WEEK 6
Lego Camp
Field Work
Field Work
Baseball
Camp
Please note that field trips may be subject to change.
Training
Session
CIT (Entering Grades 9-10)
Soccer Camp
Field Work
Lego Camp
Field Work
Soccer Camp
Antioch
Water Park
Antioch
Water Park
Aqua
Adventures
Riconda Pool
WET AND
WILD
July
11-15
WEEK 7
Field Work
Star Wars
Camp
Boomers
Boomers
Golf Land
Pixieland
OUTSIDE THE
BOX
July
18-22
WEEK 8
Field Work
Lego Camp
Camp
Jamboree
Camp
Jamboree
Camp
Jamboree
Camp
Jamboree
CAMPS GOT
SPIRIT
July
25-29
WEEK 9
WEEK 11
Field Work
Multi-Sports
Camp
Oakland Zoo
Oakland Zoo
Happy
Hallows
The Jungle
Yerba Buena
Ice Skating
Yerba Buena
Ice Skating
Yerba Buena
Bowling
Pump It Up
August
August
1-5
8-12
WHERE
DOG DAYS OF
THE WILD
SUMMER
THINGS ARE
WEEK 10
Embarcadero YMCA • 169 Steuart Steet • San Francisco, CA 94105
Community Programs Director, Shiante Lewis • Email: slewis@ymcasf.org
Field Work
Basketball
Camp
SPORTS AND SPECIALTY CAMPS (Entering Grades K-5)
Ripley’s
Believe it or
Not
MOVIN’ ON CAMP (Entering Grades 6-8)
Ripley’s
Believe it or
Not
EXPLORERS CAMP (Entering Grades 4-5)
Aquarium by
the Bay
ADVENTURERS CAMP (Entering Grades 2-3)
SF Zoo
DISCOVERERS CAMP (Entering Grades K-1)
June
13-17
June
6-10
May 31June 3
WEEK 3
WEEK 2
WEEK 1
2016 SUMMER CAMP PLANNER
11 EMBARCADERO YMCA
TRADITIONAL CAMP GROUP FIELD TRIPS
EMBARCADERO YMCA
169 Steuart Street
San Francisco CA, 94105
(415) 957-9622
www.ymcasf.org/embarcadero
CONTACT
Shiante Lewis
Community Programs Director
(415) 615-1304
slewis@ymcasf.org
EMBARCADERO YMCA
2016 SUMMER CAMP REGISTRATION
Participant’s Name:
One Per Child
Age: _______
Date of Birth: _______/_______/ ________ Grade Level (Entering Fall 2016): __________ School: ___________________________________
Home Address:
Parent/Guardian E-Mail:
Parent/Guardian #1
Please list allergies and/or medications:
Name:
Primary Phone:
Secondary Phone:
Parent/Guardian #2
Name:
Is there anything else we should know about
your child (medical/social concerns)?
Phone:
EMERGENCY CONTACTS WITH PERSONS AUTHORIZED TO PICK UP CHILD
In case of an emergency we will contact the parent/guardians first. In the
event a parent/guardian cannot be reached we will contact the list below. No
adults other than the parent/guardian or people listed below can pick up your
child from our program. ID required during pick up.
Cancellation Policy:
Pick-Up #1 Name:
Deposits are non-refundable and non-transferrable.
No credits, refunds, or transfers are allowed within 14
days of the start of the program for which you are
registering. If you wish to make a change or cancel your
registration PRIOR to the 14 day deadline, you may
choose one of the following:
Pick-Up #1 Phone:
Pick-Up #2 Name:
Pick-Up #2 Phone:
1. A transfer to another YMCA program (registration
must be available).
Pick-Up #3 Name:
2. A check or credit card refund. Please allow two
weeks for processing.
Pick-Up #3 Phone:
SUMMARY OF FEES
Deposit(s): $35 x _____ camp sessions(s) = $__________
Membership Dues: $ __________
Annual program membership cost is $50/youth or $75/family
Membership Staff will verify whether or not this needs to be renewed
Annual Giving Campaign Contribution (optional): $ __________
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Total:
YMCA of San Francisco Membership Application
Release and Waiver of Liability and Indemnity Agreement
IN CONSIDERATION of being permitted to utilize the facilities, services and programs of the YMCA (or for my children to so
participate) for any purpose, including, but not limited to observation or use of facilities or equipment, or participation in any offsite program affiliated with the YMCA, the undersigned, for himself or herself and such participating children and any personal
representatives, heirs, and next of kin, hereby acknowledges, agrees and represents that he or she has, or immediately upon
entering or participating will, inspect and carefully consider such premises and facilities or the affiliated program. It is further
warranted that such entry into the YMCA for observation or use of any facilities or equipment or participation in such affiliated
program constitutes an acknowledgment that such premises and all facilities and equipment therein and such affiliated program
have been inspected and carefully considered and that the undersigned finds and accepts same as being safe and reasonably
suited for the purpose of such observation, use or participation by the undersigned and such children.
IN FURTHER CONSIDERATION OF BEING PERMITTED TO ENTER THE YMCA FOR ANY PURPOSE INCLUDING, BUT NOT LIMITED TO
OBSERVATION OR USE OF FACILITIES OR EQUIPMENT, OR PARTICIPATION IN ANY OFF-SITE PROGRAM AFFILIATED WITH THE
YMCA, THE UNDERSIGNED HEREBY AGREES TO THE FOLLOWING:
1. THE UNDERSIGNED, ON HIS OR HER BEHALF AND BEHALF OF SUCH CHILDREN, HEREBY RELEASES, WAIVES, DISCHARGES AND
COVENANTS NOT TO SUE the YMCA, its directors, officers, employees, and agents (hereinafter referred to as “releasees”) from all
liability to the undersigned or such children and all his personal representatives, assigns, heirs, and next of kin for any loss or
damage, and any claim or demands therefor on account of injury to the person or property or resulting in death of the
undersigned, whether caused by the negligence of the releasees or otherwise while the undersigned or such children is in, upon,
or about the premises or any facilities or equipment therein or participating in any program affiliated with the YMCA.
2. THE UNDERSIGNED HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS the releasees and each of them from any
loss, liability, damage or cost they may incur due to the presence of the undersigned or such children in, upon or about the YMCA
premises or in any way observing or using any facilities or equipment of the YMCA or participating in any program affiliated with
the YMCA whether caused by the negligence of the releases or otherwise.
3. THE UNDERSIGNED HEREBY ASSUMES FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH OR PROPERTY
DAMAGE to the undersigned or such children due to negligence of releasees or otherwise while in, about or upon the premises of
the YMCA and/or while using the premises or any facilities or equipment thereon or participating in any program affiliated with
the YMCA.
4. THE UNDERSIGNED HEREBY GIVES PERMISSION for the YMCA of San Francisco, or any of its branches, to use any photographs
or video footage taken of the undersigned and/or the undersigned’s children participating in YMCA of San Francisco activities for
future YMCA promotional purposes, including without limitation, media materials, promotional print pieces, promotional video
pieces, social media platforms and Web sites of the YMCA of San Francisco and its affiliate branches, without additional release
or authorization.
THE UNDERSIGNED further expressly agrees that the foregoing RELEASE, WAIVER AND INDEMNITY AGREEMENT is intended to be
as broad and inclusive as is permitted by the law of the State of California and that if any portion thereof is held invalid, it is
agreed that the balance shall, notwithstanding, continue in full legal force and effect. THE UNDERSIGNED HAS READ AND
VOLUNTARILY SIGNS THE RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT, and further agrees that no oral
representations, statements or inducement apart from the foregoing written agreement have been made.
I HAVE READ THIS RELEASE.
Signature of applicant/parent: _______________________________________________________________________________________ Date: _____/_____ /______
Print name of applicant/parent: _____________________________________________________________________________________________________________________
Signature of co-applicant/parent: _____________________________________________________________________________________ Date: _____/_____ /_____
Print name of co-applicant /parent: _________________________________________________________________________________________________________________
Print name(s) of child(ren) in program: _____________________________________________________________________________________________________________