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*

Active DutyActive Guard and Reserve (AGR) - Full TimeOther
Please select rank*

E1E2E3E4E5E6E7E8 and up01-0405-010
Branch of Service*

ArmyMarinesAir ForceNavyCoast GuardOther
Assigned Duty Station*

Joint Base Lewis-McChordNaval Base KitsapCoast Guard Sector Puget SoundOther
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*

Wounded or injured in serviceIllness related to service 2Deployed in the last 18 monthsPCS in the last 18 monthOrders for deployment in next 6 monthsRetired or dischargedNone of the aboveOther
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
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