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YWCA of Greensboro Eliminating Racism, Empowering Women
The YWCA is the oldest and largest multicultural women’s organization in the world
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Programs and Services
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YWCA Greensboro Summer Camp 2019
YWORLD Summer Camp 2019 Application
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Who We Are
About
Mission
2023-24 Board Of Directors
Our Staff
YWCA History
FAQ’s
Get Involved
Employment Opportunities
Volunteer
2023 Preserve the Legacy Campaign
Events and Rentals
Annual Meeting
Golf Tournament
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Lunch & Learn
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2019 Academy of SHEroes Gala
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YWORLD Summer Camp 2019 Application
YWCA Greensboro Summer Camp 2019
Please Read the application carefully, More details of what is expected of you and your camper are included within it.
Camp Sessions (Monday through Thursday)
*
July 15 - 18, 2019 $50.00
July 29 - August 1, 2019 $50.00
August 5 - 8, 2019 $50.00
August 12 - 15, 2019 $50.00
Camper Name
*
First
Last
Nickname / Preferred Name
Age
Please enter a number from
1
to
18
.
Gender
Preferred Pronoun: He, Him, His/She, Her, Hers /They, Them, Theirs/Other
Home Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Camp T-Shirt Size (Adult Sizes Only):
Race/Ethnic Group:
Hispanic or Latino
Yes
No
Is transportation needed to camp?
*
Yes
No
If Yes, which pickup location is best?
*
Brassfield Cinema (Parking Lot)
Western Guilford Middle School (Car Rider Lot)
Greensboro Arboretum
N/A
* Transportation will not be provided back to this location, campers must be picked up from the YWCA building.
Participant’s Medical Information:
Is your camper allergic to anything?
*
Yes
No
If yes, please explain below
Is your camper currently under a doctor’s care?
*
Yes
No
If yes, please explain below
Is your camper on any continuous medication/s?
*
Yes
No
If yes, please explain below
Any previous hospitalizations and/or operations?
*
Yes
No
If yes, please explain below
Is there anything else about your camper that we should know prior to camp?
*
Yes
No
If yes, please explain below
Parent / Guardian Contact Information
Parent and/or Guardian’s Name
*
First
Last
Home Phone
*
Cell Phone
Work Phone
Would you prefer communication via text message
Yes
No
Email Address
*
Emergency Contacts
(Other than Parent and/or Guardian)
Name
*
First
Last
Relationship to Camper
*
Phone
*
Name
*
First
Last
Relationship to Camper
Phone
*
Please list the following people whom Do NOT have your permission to pick up your child/children/ward
**Please provide the YWCA of Greensboro a copy of any custody, visitation orders, and/or other agreements.
Summer Camp Attendance & Fee Requirements
Parents and/or Guardian, Please read the following details and check below the designated box to indicate your personal understanding of an agreement with the terms listed below:
Summer Camp 2019 Fee: Each family is required to pay the $60.00 registration fee, per session and per child. You are checking here that your understand the following fee will be due once your child/children have been approved to attend the YWCA Summer Camp Program. After the registration fee has been paid, there are no other fees. When appropriate, campers will have the option of bringing spending money for souvenirs or other items on field trips.
*
I Understand
Leaving the Program: The YWCA Greensboro requires a two-day notice if your child will be leaving the program (with the exception of dismissal from the program). If your child leaves the first session and you have paid for other sessions, you will be refunded the fees for unattended sessions. No refunds will be given if your child leaves a session before its conclusion.
*
I Understand
Action after Leaving Program: Once a notice has been given and the child/children will be leaving the program, their slot will be given to the next person on the waiting list
*
I Understand
Action Required for Parents: Parents and/or Guardians will be responsible and required to contact the Director of Youth Organizing and Services for re-entry to the program.
*
I Understand
Cell Phone Usage will be restricted during camp hours. The YWCA Greensboro Program Manager and Staff have operating phone numbers available for parents in cases of emergency and/or pick-ups to avoid disruption of campers and their learning/engagement.
*
I Understand
Manager and Staff have permission to provide each student with a designated slot for their phone with their name on it, solely for easy access in case of emergencies. And also provide parents with the Summer Camp Counselors operating phone numbers, in case of emergencies.
*
I Understand
I hereby give permission for my child/children to participate in the YWCA Greensboro Summer Camp Program 2019. In consideration of my child/children/ward’s acceptance as a participant in the program, I hereby do release and discharge the YWCA Greensboro, it’s agents, representatives, staff, and volunteers associated within the YWCA Greensboro, of all liabilities connected with their participation in this program.
*
Yes, I Consent
Agreeing to this form grants permission for the following:
*Permits the staff and volunteers of the YWCA Greensboro to transport your child/children on any outings to and from, and any activities/meetings sponsored by the YWCA. I understand that my child/children will be transported by bus, van, or car. I release the YWCA from any liability in connection with the Summer Camp Program—including any liability resulting from all recreational and instructional activities, field trips, and transportation.
*Interviews, surveys, evaluations, questionnaires of program material and services received.
*I understand that there will be educational information on the following topics: Healthy/Unhealthy relationships, communication, goal setting, volunteering, privilege, disabilities, and civil rights.
*Media coverage of the Summer Camp Program—Interviews, photos, videotaping, and radio.
*Authorize the YWCA staff and volunteers to seek and approve any medical treatment for my child/children/ward when I cannot be reached in the event of an emergency. I agree to hold the YWCA and the Physician or hospital treating the above named minor harmless.
Signature of Acknowledgment
*
I Agree
I acknowledge that I have read the YWCA Summer Camp 2019 Application, Attendance, Consent and Liability forms in its entirety. I have full and complete knowledge and understanding of what I read, and I agree to all of the terms and policies within this document. I understand that upon completion of the application I am required to pay fees indicated within it, as well as give full permission to the YWCA Greensboro Summer Camp Program Manager, Staff, Volunteers, Transportation to care for my child/children while he/she/they are under their watch. I agree that any emergencies, situations, incidents that occur will be handled and communicated with the parent/s and/or guardian/s. I also, in correspondence with the YWCA, grant them full permission to take my child/children/ward’s cell phone/s at the beginning of class to allow my child/children the optimum Summer Camp 2019 experience, and expect to get in contact with Summer Camp Program Personnel when/if I need them.
For questions or concerns contact:
Monica Bennett | YWCA Summer Camp Director Email mbennett@ywcagsonc.org
Name
This field is for validation purposes and should be left unchanged.
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