Counting down to Summer Camp 2010: 2010-6-20 14:00:00 GMT-05:00

Register for Camp Conrad Weiser 2010

Camper's Name: Date of Birth: Age:
School Grade Fall '10: First Year Attending Camp: Male: Female:
Home Phone:	Family E-Mail:
Parent 1 Information	Parent 2 Information
Name:	Name:
Relationship to Camper:	Relationship to Camper:
Occupation:	Occupation:
Business Phone:	Business Phone:
Cell Phone:	Cell Phone:
Home Address:

City or Town: State: Zip:

Emergency Contact (If the Parent/Guardian cannot be reached, please contact the person listed below)
Name:	Relationship to Camper:

Home Phone: Business Phone: Cell Phone:


Please Check all sessions applied for: $200 deposit is required for each camp session.
Session	Date	2009 Rates
Session 1	June 20 - 26, 2010	$655.00
Session 2	June 27 - July 10, 2010	$1295.00
Session 3	July 11 - 24, 2010	$1295.00
Session 4	July 25 - August 7, 2010	$1295.00
Session 5	August 8 - 14, 2010	$655.00

Deposit or Payment Information:

Amount to Charge $ ($200 deposit required for each session)

Charge my Credit Card

Credit Card Number: Security Code:

Cardholder Name: Expiration Date:

Please Note: We Guarantee to honor requests for cabin mates, in pairs only, if requests are mutual
and campers are within the same age/grade range. We can only guarantee 2 requests per cabin.

How Did You Hear About Camp? Buddy Request:

Age Requirements
Ages 7-15
Deposits & Tuition
• To be eligible for early bird rates, a $200.00 deposit per session is due by December 1, 2009.
• Half of the remaining balance is due by March 1, 2010.
•All remaining balances are due by May 1, 2010.
• Methods of payment accepted: check,MasterCard, Visa, Discover or American Express.
Cancellations & Refund Policy
• All deposits are refundable until February 1, 2010 minus the deposit.
After this time, no refund will be given except as follows:
• If a cancellation occurs for a physician-documented medical reason all fees, MINUS
the deposit will be refunded.
• If during a session it is advised to send a camper home for medical reasons, the
remaining portion of the session will be refunded.
• No refunds will be made for late arrivals or early departures.
• In case of homesickness, dismissal, or voluntary withdrawal there is NO refund of
any fees.

Please Read:
After registering an invoice will be sent to each parent. Prior to camp additional
detailed information will be sent to each registered participant.
By clicking the SUBMIT Button below, I have read, understand and agree to the provisions
outlined in this document. I certify that the camper applicant is capable of participating
in an active camp experience.

Click here for A CA CEO Peg Smith answers parents' questions regarding H1N1 and summer camp Contact Us South Mountain YMCA PO Box 147 - Wernersville, - PA 19565 telephone: 610.670.2267 fax: 610.670.5010 email: ycamps@smymca.org

"The mission of South Mountain YMCA is to provide a camping experience, educational and other programs that build personal leadership, character and life skills while developing caring, honesty, respect and responsibility in young people, families and communities"