Summer Camp Registration Form (Midtown ONLY)

Summer Camp Registration Form

YWCA Midtown
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 completing:*
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.Format: (000) 000-0000.
Email*
example@example.com

Payment Options
A one-time registration fee of $125 is required. Please select your payment option below.
Please select your payment type*
Please note, your registration is not finalized until you've received an invoice for this payment from Procare.

Immunization Records

Please upload your child's immunization records. If you do not have those records, you can email them to summercamp@ywcampls.org. NOTE: Immunization records are required before the start of camp.
File Upload

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

Summer Camp Registration Form