Please Bill My *
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For Total of All Camp Fees
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For Total of All Required Camp Deposits
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If paying deposit only, please select one of the following payment plans:
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No Payment Plan
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Invoice me for the remainder of total fees in March
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Charge my credit card monthly *
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* Equal payments thru April 2012 – if enrolling after March 1st – we will contact you for payment arrangements. |
| Card No.* |
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CVV
Code
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| Cardholder Name* |
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| Expires* |
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Credit Card Billing Information the same as the Person Financially
Responsible Information. Otherwise please complete the fields below. |
| Card Billing Address* |
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| Card Billing City* |
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| Card Billing State* |
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| Card Billing Zip* |
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| Person financially responsible
for camper* |
| Name* |
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| Phone* |
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| Address* |
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| City* |
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| State* |
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| Zip* |
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| Relationship to camper:
mother
father
guardian
other
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Cancellation policy/agreement:
I hereby apply for my child to attend Camp Manito-wish
YMCA. Enclosed you will find the required deposit
which I understand will be credited toward the camp
fee if my child is accepted for enrollment. I agree
to pay the total camp fee on or before April 30, 2012.
I understand that in
the event of cancellation:
- Before February 1, Camp
Manito-wish will retain 25% of the full deposit.
- Between February 1 and
June 1, Camp Manito-wish will retain the full deposit.
- In the event of cancellation
on or after June 1, dismissal due to misconduct,
or withdrawal due to homesickness, Camp Manito-wish
will retain 100% of the session fee. If a medical
condition (confirmed by a physician) occurs, Manito-wish
will retain $100 and refund the pro-rated balance.
I understand the terms covering payment of camp
fees and hereby give my approval and consent to
the application.
Photo/image-use information:
I hereby give permission
to use any video, photographs, or written statements
from my child's experience in public relations materials
including the internet without compensation. |
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I have read the above Cancellation and Photo Information and agree
to all the terms* |
Waiver information:
I understand that although Camp Manito-wish YMCA has
taken reasonable steps to provide my child with appropriate
training, equipment and skilled staff for his/her camp
experience, I acknowledge that some inherent risks cannot
be eliminated without destroying the unique character
of these activities. Such risks include, but are not
limited to, those associated with canoeing, portaging,
backpacking, sea kayaking, waterfront activities, horseback
riding, wildlife, vehicle transportation, and other
components of the camp experience and wilderness travel.
Aware of the risks and willing to assume them, I hereby
waive, release and agree to hold harmless the Camp Manito-wish
YMCA Inc., their representatives and successors for
all claims or liabilities of any kind arising out of
my child’s participation in this camp experience.
I have read the descriptions of the session, understand
the requirements for participation, and give my child
permission to participate. I assume and accept full
responsibility for his/her participation.
IN CASE OF SURGICAL EMERGENCY, I hereby give
my permission to the physician selected by the Camp
administration to hospitalize, secure proper treatment
for, and order injection, anesthesia or surgery for
my child. I accept responsibility for medical/surgical
treatment charges which may be incurred on my child's
behalf. |
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I have read the above Waiver Information and agree to all the terms* |
| Applications are processed in the
order they are received. The session you are applying
for may be full. You will be contacted if you are placed
on a waitlist for the program of your choice. Confirmation
letters of the receipt of your application will be mailed
soon. |
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