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Parent 1
Parent 2
Step
Step
Medical
Authorizations
Pick-Up
Summer Camp Registration Kentucky
member-id
Today's Date*
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/
Child's Name*
Child's Date of Birth*
/
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Child's Gender*
Child's T-Shirt Size*
Choose One
Youth XS
Youth S
Youth M
Youth L
Adult S
Adult M
Adult L
Adult XL
Age (during majority of time at camp)*
Child's Height*
Child's Weight*
Child's Race*
White/Caucasian
Black/African American
American Indian
Hispanic
Multi-Racial
Native Hawaiian/Pacific Islander
Asian
Other
The YMCA receives funding from many sources to support summer camp scholarships and programming. Providing the following information helps us continue to make a case for support. All information is kept strictly confidential.
Household Income*
Less than $20,000
$20,000-$30,000
$30,000-$40,000
$40,000-$50,000
$50,000+
Child lives with...*
Both Parents/Guardians
Mother Only
Father Only
Other
Marital Status of Parents*
Married/Same Household
Divorced
Separated
Single
Total number of people in your household?*
Additional Siblings in Camp*
No
Yes
Sibling Name*
Age*
Sibling Name
Age
Sibling Name
Age
Sibling Name
Age
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In the event of an illness/emergency, the following individuals will be contacted in the order listed. These individuals also have authorization to pick up the above named child. Two contacts must be listed! Adults authorized to pick up a child must be 18 years of age or older.
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