YMCA Camp Cory
Family & Teen Programs

Family Name:  This will be our year at Camp Cory.
Address:  City:  State:  Zip:
E-Mail Address:

 

We would like to attend: (Please check the appropriate boxes)
Memorial Day Weekend Family Camp May 28-31, 2010
Ages 0-3
Ages 4-12
Ages 13 and up		 Free
$130
$160
Labor Day Weekend Family camp September 3-6, 2010
Ages 0-3
Ages 4-12
Ages 13 and up		 Free
$130
$160
Daddy & Me Weekend September 17-19, 2010
Daddy & Child
Each Add'l Child		 $180
$80

There is a $50 registration fee per family for those participants who are not members of the YMCA.
YMCA Member? Yes No Branch:
Adult Participants
1. Name: Birthdate: Male Female
    Home Phone: Work Phone:
2. Name: Birthdate: Male Female
    Home Phone: Work Phone:
Youth Participants
1. Name: Birthdate: Male Female
2. Name: Birthdate: Male Female
3. Name: Birthdate: Male Female
4. Name: Birthdate: Male Female
Additional Participants (adult and/or children) or special comments
Registration & Deposit
A $50.00 deposit and $50.00 registration fee (registration fee applies only for those who are not YMCA members) per family, if applicable, is due at the time of registration. This deposit is NON-REFUNDABLE and final payment is due at least 30 days prior to the program.
Credit Card Type
Name on Card:
Account Number:
Expiration Date:
Security Code: (back of card)
I hereby authorize the YMCA of Greater Rochester to debit the credit card provided for the deposit and registration fee, and to charge the balance to this card the 5th Monday prior to each registered session.
I hereby authorize the YMCA of Greater Rochester to debit the credit card provided for the total amount of Family Camp program fees.
Ethnic Origin:   Household Income Level:   How did you hear about us?

 

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