Armed Services YMCA Campership Application

Armed Services YMCA Campership Application
YMCA Camp Seymour
Camper #1 Name

First NameLast Name
Camper #1 Date of Birth

MonthDayYear
Date
Camper #2 Name

First NameLast Name
Camper #2 Date of Birth

MonthDayYear
Date
Camper #3 Name

First NameLast Name
Camper #3 Date of Birth

MonthDayYear
Date
Parent #1 Name (Service Member)*

First NameLast Name
Parent #1 - Date of Birth

MonthDayYear
Date
Service Status

Other
Please select rank
Branch of Service

Other
Assigned Duty Station

Other
Parent #2 Name (Spouse, POA or Guardian)

First NameLast Name
Parent #2 - Date of Birth

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number

Area CodePhone Number
Please check all that apply

Other
By signing below I agree that the submitted information is correct and agree to receive communication from the YMCA of Pierce and Kitsap Counties. I understand that I will be contacted by email if my child is selected for an Armed Services YMCA Campership and that the $25 deposit per child must be paid to reserve a camp session.
Signature
Should be Empty: