2010 LAKE STOCKWELL SUMMER DAY CAMP REGISTRATION FORM
We would like to extend our sincerest appreciation to you for being part of our camp family. We know the concerns for your child include keeping them safe, exposing them to positive role models, and improving their self respect through skill development. We are very proud of our success in these areas and in the selection of our professional, caring staff. They are the cornerstones of that success. If you and your camper had a positive experience at Camp this past summer, the nicest thing you can do for us is share the experience with others by referring us to your friends and families. We look forward to seeing you for summer 2010!

Please take careful notice of our new pricing and discounts that can add significant savings to your camp experience. Based on the feedback of our camp families, we listened and adopted family friendly pricing that offers discounts for siblings, discounts for signing up for more than one session and early bird discounts as well. For overnight camp, realizing that families have different abilities to pay, we are also offering 3 levels of pricing from which you pick the price that is most comfortable for your particular situation. The program in no way influences the experience your child receives, but is simply another way for us to offer convenience and choice to our camper families. For day camp, parents who need camp can now reap significant benefits for signing up for multiple sessions with prices that are up to 25% below last year’s prices.

Please fill out the form completely or, if you prefer, download a pdf of the registration form.

CAMPER INFORMATION:
Last Name:	A value is required.
First Name:	A value is required.
Male Female Please make a selection.	Returning Camper
Birth Date: (mm/dd/yyyy)	A value is required.Invalid format.
School Name:	A value is required.
Grade Entering Sept. 2010:	A value is required.
FAMILY INFORMATION: Applies to the Parent/Guardian with whom the camper legally lives. Non-custodial parent information is below.
Camper Address:	A value is required.
City:	A value is required.
State:	A value is required.
Zip:	A value is required.
Father/Guardian 1
Last Name	A value is required.
First Name:	A value is required.
Home Phone: xxx-xxx-xxxx	A value is required.Invalid format.
Work Phone: xxx-xxx-xxxx	A value is required.Invalid format.
Cell Phone: xxx-xxx-xxxx	A value is required.Invalid format.
Employer's Name:	A value is required.
Occupation:	A value is required.
Email: Camp Forms will be e-mailed	A value is required.Not a valid email address.
Mother/Guardian 2
Last Name	A value is required.
First Name:	A value is required.
Home Phone: xxx-xxx-xxxx	A value is required.Invalid format.
Work Phone: xxx-xxx-xxxx	A value is required.Invalid format.
Cell Phone: xxx-xxx-xxxx	A value is required.Invalid format.
Employer's Name:	A value is required.
Occupation:	A value is required.
Email: Camp Forms will be e-mailed	A value is required.Not a valid email address.
NON-CUSTODIAL PARENT
Has there been a divorce/separation?      Yes No Please make a selection.

If yes, who has custody?
Please check all that apply below.
The non-custodial parent should be contacted in the event of emergency
Receive duplicate mailings
Receive invoices

NON-CUSTODIAL PARENT
Last Name
First Name
Home Phone xxx-xxx-xxxx
Work Phone xxx-xxx-xxxx
Cell Phone xxx-xxx-xxxx
Address
City
State
Zip
Email

EMERGENCY CONTACTS: List two contacts other than parent(s)/guardian(s)
Contact One
Name	A value is required.
Relationship	A value is required.
Home Phone xxx-xxx-xxxx	A value is required.Invalid format.
Work Phone xxx-xxx-xxxx	A value is required.Invalid format.
Cell Phone xxx-xxx-xxxx	A value is required.Invalid format.
Contact Two
Name	A value is required.
Relationship	A value is required.
Home Phone xxx-xxx-xxxx	A value is required.Invalid format.
Work Phone xxx-xxx-xxxx	A value is required.Invalid format.
Cell Phone xxx-xxx-xxxx	A value is required.Invalid format.

ADDITIONAL INFORMATION: Your feedback in this section is very important to us
Please tell us how you originally heard about our camp. Please be specific and check all that apply. Print Advertisement
Magazine/Ad	Name:
School Flyer	School:
Flyer in a YMCA	YMCA:
Internet
mysummercamps.com	gocamps.com
campchannel.com	ACA website
YMCA website	Other:
Camp Fair/Program
Camp Fair	Which fair:
Attended other camp program	Which program:
Word of Mouth Referral      We heard about your camp through:
A friend who attended camp	Other
A relative who attended camp	Who specifically: