Laserfiche WebLink
ELK RIVER YMCASUMMER PROGRAM REGISTRATION FORM <br /> ,1 <br /> • Please refer to Registration Process boxes for detailed Participant Infermatien <br /> registration information. I Child's Name <br /> I.One child per Registration form.Please make copies for Parent/Guardian Name <br /> additional children. Billing Address <br /> 2.Review session and bus schedule.Completely fill out the City/State/Zip <br /> Registration form and the Health History form. ' Home Phone <br /> 3. Return completed registration form and non-refundable Date of Birth <br /> deposit for each session or full payment to: This will be my child's year at Camp Manitou/YMCA Summer Power <br /> Elk River Recreation Department Please pair my child with(limit two; must be registered for same program and session) <br /> 1104 Lions Park Drive,Elk River, MN 55330 <br /> or fax to:163-274-1842 <br /> (must include credit card information) Payment information <br /> This is a (check one) 0 Deposit 0 Full Payment 0 Amount $ <br /> 4.A confirmation letter will be sent to you within two <br /> weeks.You will be billed for the remaining balance,which 0 Check Enclosed 0 Credit Card: Visa _MC _Discover _Am. Ex. , <br /> must be paid 1 week prior to the start of the session. = Name on Card <br /> s <br /> Card Number Exp. Date <br /> Bus Information (Camp Manitou Only) <br /> Bus Location I agree to pay above <br /> Total amount according <br /> $25/Week YMCA Before&After Care: 50th Main Street i to card issuer agreement X <br /> F Yes F No Em orium Building)( P g) Please include appropriate NON-REFUNDABLE deposit per session per registration.$25 for Summer Power and Summer Uproar Programs <br /> $25/Week YMCA Before&After Care at Camp Manitou l and$50 for Day Camp Manitou <br /> F Yes F No <br /> IP <br /> • <br />