(PLEASE READ CAREFULLY)

The registration form is correct to the best of my knowledge and the child herein described has permission to engage in all prescribed activities, except noted by me. In the event I can not be reached in an emergency, I hereby give permission to the physician selected by the adult leader in charge to hospitalize, secure proper anesthesia, or to order injection or surgery for my child.

I understand that the YMCA does not provide accident insurance coverage for participants. I am responsible for my own coverage.

I have read the rules and policies of the YMCA Day Camp handbook. I understand the YMCA adheres to these rules. I agree to follow the policies of the YMCA. I understand that my failure to do so may result in my child being discharged from the program. Your signature below indicates that you have received the day camp handbook.

I understand that the YMCA staff and volunteers are not allowed to baby-sit or transport children at any time outside of the YMCA program. Immediate disciplinary action will be taken by the YMCA towards the staff and volunteers if a violation is discovered.

I understand that payment is expected in advance and that there will be a late fee assessed should I neglect to pay on time.

I understand that by enrolling my child in the YMCA program that I have committed to the program for the summer weeks that I have selected and that I am charged regardless of my child’s participation. I understand that in order to remove my child from the YMCA program I must fill out a YMCA exit form at least one week prior to my child’s last day of attendance.

I understand that I am not to leave my child at the YMCA or program site unless a YMCA staff or volunteer is there to receive and supervise my child.

I understand that my child will not be allowed to leave the program with an unauthorized person. Any person authorized to pick up my child must either be listed with the YMCA or other arrangements must be made by calling the YMCA office to inform them of a change.

I understand that should a person arrive to pick up my child who appears to be under the influence of drugs or alcohol, for the child’s safety, staff may have no recourse but to contact the police. Please do not put staff in a position in which they have to make a judgment call. (Example: If they smell alcohol then the child is not released.)

I understand that the YMCA is mandated, by state law, to report any suspected cases of child abuse or neglect to the appropriate authorities for investigation.

I have received a copy of the YMCA employee Code of Conduct, Summer Day Camp Handbook and Summary of Licensing Requirements. (Licensing Requirements are given a State Licensed Day Camps Only.)

I hereby consent to the use of my child’s likeness in photographs, film or videotape for the use in editorial, illustration or promotional purposes.

The YMCA considers all registrations without regard to race, color, religion, sex, national origin and presence of medical condition or handicap. However, the YMCA does reserve the right to refuse admission to any child who may require a level of attention beyond that which the YMCA programs are designed to accommodate or require specialized training that may prevent the YMCA staff from adequately meeting the needs of the child.

Limited financial assistance is available.