QYU Summer Camp Registration Form

QYU Summer Camp 2026 Registration Form

Complete the form below for each individual youth. Complete all 4 sections below.

July 6-17 - Masterpiece (Belleville) - COST $250Aug 10-14 - Masterpiece (Napanee) - COST $125Aug 17-21 - Masterpiece (Quinte West) - $125Aug 17-21 (9am-12pm) - Graphic Word Creator's Camp (Belleville) - COST $70Aug 17-21 (1pm-4pm) - Graphic Word RPG Camp (Belleville) - COST $70Aug 24-28 (9am-12pm) - Graphic Word Gamer Camp - COST $70

Youth Name*

Birthday:*

MonthDayYear

T-Shirt Size*

School grade in September 2026:*

Please list any allergies the student may have and treatment.

Does the student have any physical, mental or emotional disability, chronic condition or recent illness which the staff should be aware of or that may require medical attention. Please comment in field below.

Home Address*

My home address is also my billing address for payment?*

Only important for credit card payment

Billing Address for payment

Parent/Guardian 1 Name:*

Relationship to youth*

E-mail*

Phone Number*

Parent/Guardian 2 Name:

First NameLast Name

Relationship to youth

Relationship

E-mail

example@example.com

Phone Number

Area CodePhone Number

YesNo

YesNoOther

Any other comments or questions?

How will you be paying?*

Total cost for camp registration

*You selected Credit card.

NOTE: please make sure your ADDRESS is completed correctly. If there is a mistake the entire form will reset when you click submit. This can be frustrating. For an alternate credit card payment: change HOW YOU WILL BE PAYING to CASH, and then pay with credit card at www.QYU.ca/pay. Make sure to add a note in your payment for what the payment is for.

CREDIT CARD PAYMENT

CADEnter amount to pay

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

Payment Comment

This helps pre-fill the payment form

PAYING WITH CREDIT CARD

Please make sure your details (name, address, etc.) are filled in correctly, and when you submit this form you will be redirected to the payment form with most of the details pre-filled for you.

PAYING VIA E-TRANSFER

Please send your E-Transfer to info@qyu.ca. Please include a note of your childs name and which camp you are paying for.

Auto-deposit is enabled so no password is required.

AFTER SUBMITTING, COMPLETE YOUR E-TRANSFER THROUGH YOUR BANK

PAYING WITH CASH OR CHEQUE

MAIL to the QYU office at P.O. Box 233, Belleville, ON K8N 5A2.

DELIVER to the QYU office during regular business hours (please call before arriving) at 444 Dundas St West, Belleville.

GIVE to a QYU camp leader before camp begins.

AFTER SUBMITTING, PLEASE REMEMBER TO COMPLETE YOUR CASH OR CHEQUE PAYMENT

Please verify that you are human*

Section 1. CAMP SELECTION

Section 2. YOUTH ATTENDING

Section 3. PARENT / GUARDIAN INFO

Section 4. PAYMENT