Phantom Lake YMCA Camp 2013

Mail to: S110W30240 YMCA Camp Rd., Mukwonago, WI 53149 Fax to: (262) 363-4351
To qualify for Early Bird pricing, you must register by December 1st, 2012 and put a $100 non-refundable deposit. Selection of session and payment in full is required by March 1, 2013.

Early Bird Application

Plan ahead and SAVE on a summer experience that your camper loves!
Magnificent 7 and 8 Year Olds
Campers must be 7 or 8 at the start of the registered session. The week session is designed for greater supervision for 7 and 8 year old campers. Registering for the A and B sessions is acceptable and encouraged.

Campers Name Birthday Address Home Phone Parent 1 Name Parent 2 Name Recruited by (non-sibling) Recruiters City/State Grade as of 09/01/2013 City Family Email (required) Parent 1 Cell Phone Parent 2 Cell Phone Tentmate Requests 1 2 This is my

Gender Male

Female

year as an overnight camper. State Zip Code

Date

Session

Age

Early Bird Holdover Price Program

Work # Work #

(Up to 2 tentmate requests permitted)

June 16-19 June 19-22 July 7-10 July 10-13 July 14-17 July 17-20 *Undecided

Mag Coed I A Mag Coed I B Mag Boys A Mag Boys B Mag Girls I A Mag Girls I B *Unknown

7-8 7-8 7-8 7-8 7-8 7-8 7-8

$265 $265 $265 $265 $265 $265 $265

Free Free Free

Traditional Week Long Camp Sessions

Starting at age 8 (Check the session and fill in the pricing below) Early Bird Price Holdover Program $ 95
$ $ $ $ $ $ $ $ $

Add On Specialty
For campers entering 3rd grade or older.

Add On Specialty
For campers entering 6th grade or older.

Session Dates

Resident Camp Session

Age

PLYC Swim Lessons $ 40

$ $ $ $ $ $ $ $ $

Skate Park Specialty $ 70

$ $ $ $ $ $ $ $ $

Fishing
With Dr. Bob

$ 50
$ $ $ $ $ $ $ $ $

Golf Specialty $ 95
$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $

Adv. Crafts $ 40

Cre8ve Writing $ 40
$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $

Soccer $ 40

Lacrosse $ 40
$ $ $ $ $ $ $ $ $

Basketball $ 40
$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $

Disc Sports $40

$ $ $ $ $ $ $ $ $

Sailing $75
$ $ $ $ $ $ $ $ $

Session Total

June 16-22 June 23-29 June 30-July 6 July 7-13 July 14-20 July 21-27 July 28-Aug 3 August 4-10 August 11-17

Coed Camp I Coed Camp II Teen Camp Boys Camp Girls Camp I Girls Camp II Coed Camp III Coed Camp IV Coed Camp V

8-15 8-15 13-17 8-15 8-15 8-15 8-15 8-15 8-15

$500 $550 $550 $550 $550 $550 $550 $550 $550

Holdover Program Add On SpecialtyLimited Space Available

If you are planning to attend two consecutive sessions, you may register for the Holdover Program. Holdover participants will enjoy camp programs during the period between sessions. Activities are supervise and led by PLYC Staff. Laundry and meals are included in the Holdover Program fee. Each of the Add On Specialties provide 8-9 total hours of small group instruction during the morning specialty periods. Campers registered for an Add On Specialty Program will enjoy the benefits of a specialty camp with and will enjoy the traditional PLYC experience in the afternoon and evening programs, as enjoyed by the general camp population. Campers that enroll in AOS must meet the grade requirements to participate. The AOS program will be led by skilled activity instructors. * * ONLY ONE ADD ON SPECIALTY MAY BE SELECTED PER SESSION * *

Summer 2013 Open Session

Take advantage of Early Bird pricing and sign up for the 2013 Unknown Session. Inform camp of your session choice before March 1, 2013 for your guaranteed spot at the Early Bird rates *UNDECIDED

*UNKNOWN

$550

Early Bird Application Details: In order to qualify for our Early Bird Pricing you must register for camp before December 1st, 2012. A $100 non-refundable deposit per session must be submitted with this registration. Camp sessions must be selected, and the balance of all fees must be paid by March 1, 2013 in order to maintain your Early Bird Pricing agreement. Early Bird Camp Fee Program: The balance of all sessions is due by March 1, 2013 to receive the Early Bird Pricing. Session fees will increase March 1, 2013 to 2013 prices (Coed I - $550, the rest of the week long sessions will be listed at $590 each, Magnificent 7 & 8 Year Old Sessions will be listed at $305). If you change your sessions after June 1 there will be a $50 fee. Early Bird Deposit: A $100 non-refundable deposit per session is required with the registration form. The deposit is deducted from the total camp fee. Multiple Session Discount: You may deduct $50 for any additional resident camp session within the same family. Tentmate Request: A mutual request is formed when your child requests ONLY one or two campers and the requested camper(s) requests your child. Campers must request each other, be within one year of age, the same gender and enrolled in the same session. Campers are assigned to tents by school grade and by age. If there is a group larger than 3, please discuss the grouping assignments with the families involved to choose groups of NO MORE than 3 campers. If there are groups of more than 3, PLYC will decide groups at our discretion. PLYC attempts to fulfill all mutual tentmate requests. Tentmate requests received within 2 weeks of the session start date are not guaranteed, but will try to be honored. Recruitment Program (offer ends 01/31/2013): Recruit this fall & winter to save! Refer a friend and receive a 20% rebate check for the paid registration fee. Your referral must be new to camp, and mention you or your family on their registration form at the time of registration and must be registered by January 31, 2013. Sorry no siblings. Rebate checks will be distributed in September, after the conclusion of the 2013 summer. Parent Information Email: Shortly after you register you will receive a confirmation email. In early spring you will receive a second e-mail with our Parent Handbook and mandatory camp forms attached. Please print and complete these forms and keep the Parent Handbook to review prior to bringing your camper to camp. Contact the Camp Business Office if you prefer to receive this information by mail. This information is also available at our website: www.phantomlakeymca.org. Health Form/Parent Information Letter: Each camper is required to have had a Physical Examination by a licensed Physician within 24 months of attending camp. Each year our Health Examination Form must be completed and signed by a physician and our Camper Health Form must be completed and signed by a parent or guardian. These forms must be completed annually to ensure the safety of our campers. PLYC will retain all fees and not accept any camper without the necessary paperwork. Phantom Lake YMCA Camp welcomes any boy or girl age 7 to 17 and does not discriminate against any enrolled child and family or any applicant for enrollment in admission, privilege or enrollment, or discharge condition on the basis of age, race, color, sex, sexual orientation, creed, disability, national origin or ancestry. Required membership in the Phantom Lake YMCA Camp is included in the fee. Campers are gladly received from any part of the world, regardless of YMCA affiliation. Phantom Lake YMCA Camp reserves the right to dismiss a child from the camp whose special needs we are not able to meet, or whose conduct is not in the best interest of the total camping community, without refund.

Cancellation Policy and Release Waiver

Parental/Guardian Approval: Please total your fees from the front side and choose a payment option. I/We approve this application and certify that our child is in good health. Acceptance of this application is contingent upon the Total Camp Fees $ camper passing a physical exam by family physician within twenty-four months before attending camp. FEES DO NOT Camper Store Account Deposit $ INCLUDE MEDICAL/ACCIDENT INSURANCE. Medical bills, including prescriptions, are the responsibility of the parent. $ 30-40 / Session Recommended DEPOSIT I/We understand a deposit of $100 per child, per session will be credited toward the camp fee. For Early Bird rate, the balance of fees is due March 1, 2013. I understand in the event of cancellation before March 1, 2013 Phantom Lake YMCA Camp will retain 100% of the deposit and refund all other paid fees. After March 1, 2013, 50% of all paid fees will be returned. After June 1, 2013, 100% of all paid fees will be retained. In the event of cancellation due to misconduct or home sickness Phantom Lake YMCA Camp will retain 100% of the session fee. Camp fees include staff supervision, lodging, meals, and most program activities. Phantom Lake YMCA Camp has my permission to use any photographs, video, or written statements from my childs experience in public relations and marketing materials including internet without compensation. Phantom Lake YMCA Camp is not responsible for lost, stolen or damaged personal items. I/We understand that although Phantom Lake YMCA Camp 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 boating, waterfront activities, wildlife, and vehicle transportation. Aware of the risks and willing to assume them, I hereby waive, release and agree to hold harmless Phantom Lake YMCA Camp, Inc., their representatives and successors for all claims or liabilities of any kind arising out of my childs participation in this camp experience. I/We have read and agree to all the conditions of the application and give my child permission to participate.
Optional Tax Deductible PLYC Donation(s)

Payment Information

PLYC Strong Kids Campership Campaign $ Program Equipment Donation $

Total:
Pay Deposit ($100/session) by check Pay Full Balance by Check Pay Deposit ($100/session) by Credit Card Pay Full Balance by Credit Card Pay Deposit ($100/session) now and balance on March 1, 2013 by Credit Card
Visa or MasterCard # Cardholder Signature Exp. Date: Todays Date:

Spread the word.

Everyone, veteran to first time campers receive the discounts included in the Early Bird Registration.
(Early Bird Registration and this form expire after 12/01/2012)

Signature

Date
PARENT / GUARDIAN SIGNATURE IS REQUIRED BEFORE REGISTRATION IS APPROVED