2024 Summer Camp Registration Form

2024 Summer Camp Registration Form

YWCA Children's Center in Downtown and South Minneapolis
Child's Name*

First NameLast Name
Birthday*

MonthDayYear
Date
Select your Child's Gender:*
*If you selected other, please specify:
What grade is your child in:*
Race/Ethnicity of Participant: (Select all that applies) (Optional)

Asian or Pacific IslanderBlack or African AmericanHispanic or LatinxIndigenous American/AlaskanWhiteOther
Name of person responsible for billing*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com

Payments Types and Options
A one-time registration fee of $100 is required. Please select the payment options below.

View Camp Costs
Select your payment type:*

Automatic Payment Authorization Form

for Credit Card Payment
To pay by CREDIT CARD, please download and complete our Automatic Payment Authorization Form and email it to Erin Wigg OR upload the form below.
I will upload the completed form.*

Yes. I will uploaded the completed form.No, I will email the form to Erin Wigg at ewig@ywcampls.org
Upload Form

Cancelof
Parent/Guardian Name*

First NameLast Name
Child's Name*

First NameLast Name
Cardholder Owner Signature

Powered by Jotform SignClear
Date

MonthDayYear
Date

Automatic Payment Authorization Form

for Check Payment
To pay by CHECK, please download and complete our Automatic Payment Authorization Form and email it to Erin Wigg OR upload the form below.
I will upload the completed form.*

Yes. I will uploaded the completed form.No, I will email the form to Erin Wigg at ewig@ywcampls.org
File Upload

Cancelof
Bank Name*
Bank Account Number*
Rounting Number*
Select One*

CheckingSavings
If you selected "Savings", upload voided check/deposit slip.

Cancelof
Bank Account Owner Signature*

Powered by Jotform SignClear
Date

MonthDayYear
Date

Childcare Subsidy Provider
A current “Authorization of Service” must be on file before your child’s care may be billed to a county/third party agency.

Parent/guardian is responsible for full payment until the “Authorization of Service” is received.
Our Family currently receives childcare assistance from:
    County    Third-Party Agency    Other
County:
Third-Party Agency
Other
Agency/County Worker Name*
Phone Number*
Case #*
Paperwork submitted to County/Agency*

YesNo

Immunization Records

Please upload your child's Immunization Records. If you do you have those records, you can email them to summercamp@ywcampls.org. NOTE: Immunization records are required before the start of camp.
File Upload

Cancelof
I will email a copy of the immunization records.*

Yes, I will email the records to summercamp@ywcampls.orgNo, I have uploaded the immunization records

Camp Locations and Dates