Woodbridge Branch YMCA - Day Camp

YMCA at the Woodbridge Community Center
2008/2009 Schools Out! Vacation Care!

Please fill out all information as completely and accurately as possible.

Child's Information

*Child's First Name:

*Child's Last Name:

*Address:

*City:

*State: *Zip:

*Home Phone:

*Birth Date: *Age:

*Sex:

Male
Female

*Grade in School: *School:

*Current YMCA Member? Yes No Expiration Date:

Parent/Guardian Information

Name:

Home Phone:

Work Phone:

Email Address: Use email address for main contact

Name:

Home Phone:

Work Phone:

Email Address: Use email address for main contact

Please check off dates below.

September 2008 January 2009

Sept 30 Jan. 2

Jan. 19

October 2008

Oct. 1 February 2009

Oct. 9 Feb. 13

Oct. 13 Feb. 16

November 2008 April 2009

Nov. 3 Apr. 10

Nov. 4 Apr. 13

Nov. 5 Apr. 14

Nov. 6 Apr. 15

Nov. 7 Apr. 16

Nov. 28 Apr. 17

May 2009

December 2008 May 25

Dec. 24- until 3 pm only

Dec. 26 June 2009

Dec. 29 TBA

Dec. 30

Dec. 31 - until 3 pm only

Fees

Fees are $35.00 per day for Members and $48.00 per day for Non-Members.
(Values are automatically calculated. They cannot be changed.)

per day X Days = Total Cost

Payment

Payment can be made via check or credit card (Visa and MasterCard are accepted). If you pay by check, your registration will not be processed until the check is received.

If paying by credit card, you will be charged the amount shown above.

Name on Card:

Card:

Card Number:

Exp. Date (mm/yy):

Additional Comments: