2025 Day Camp Enrollment Form

2025 West Cook YMCA Day Camp Enrollment Form
The first step in the enrollment process for the West Cook YMCA Day Camp is to complete the following enrollment form. Once you have completed the entire form an email will be sent confirming we have received your completed enrollment form. A West Cook YMCA team member will follow up to confirm the next steps.

You can register up to 4 children residing in the same household. Additional forms that will be required include your child(ren)'s health exam form so please prepare to have it on hand so that when our staff reach out to complete the process you will be able to upload with your registration packet.

Location: West Cook YMCA | 255 S Marion St. Oak Park IL 60302

Dates: July 21st – August 8th, 2025

Ages: 6-10 years

Day and Time: Monday-Friday from 9:00am – 4:00pm

Before Extended Care: 7:00am – 9:00am

After Extended Care: 4:00pm – 6:00pm

Y Member Cost per Week: $250

Non-Member Cost per Week: $325

Extended Care Cost per Week: $50 and includes before and after extended care

Non-refundable Deposit Due Today: $25 per camper per week

Session 1 Dates: July 21-July 24

Session 2 Dates: July 28-August 1

Session 3 Dates: August 4-8

PARENT/GUARDIAN INFORMATION

Parent/Guardians listed on this page are allowed to pick up on a regular basis and under any condition.
Parent/Guardian 1 Name*

First NameLast Name
Parent/Guardian 1 Date of Birth*

MonthDayYear
Date
Parent/Guardian 1 Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian 1 Place of Work
Parent/Guardian 1 Work Phone Number *
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian 1 Email Address*
example@example.com
Parent/Guardian 1 Preferred Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian 1 Alternate Phone
Please enter a valid phone number.Format: (000) 000-0000.
YesNo
YesNo

PARENT/GUARDIAN INFORMATION (Cont.)

Parent/Guardians listed on this page are allowed to pick up on a regular basis and under any condition.
Parent/Guardian 2 Name*

First NameLast Name
Parent/Guardian 2 Date of Birth*

MonthDayYear
YesNo
Parent/Guardian 2 Place of Work
Parent/Guardian 2 Work Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian 2 Email Address*
example@example.com
Parent/Guardian 2 Preferred Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian 2 Alternate Phone
Please enter a valid phone number.Format: (000) 000-0000.
YesNo

Family Information
Family Dynamics (please share situations that may have an impact on your child(ren) so we can best support them while they are in day camp:*
Parent/Guardian 1Parent/Guardian 2Other

Approval for West Cook YMCA Activities

Please check all the appropriate choices that you are approving or not approving.
I give permission for my child(ren) to have their picture and/or video taken as part of the West Cook YMCA program. I understand that the picture or video may be displayed in marketing materials, within the facility, in the newspaper, or on other media outlets.I do NOT give permission for my child(ren) to have their picture and/or video taken for the purpose of using in marketing materials, within the facility, newspapers, or other media outlets.
I hereby give my consent for the administration of any medical treatment deemed necessary by our family doctor or another licensed physician at the closed hospital facility.I do NOT give my consent for the emergency medical treatment beyond basic first aid for my child. In the event of sudden illness or injury requiring emergency medical treatment, I hereby give the YMCA staff authority to do the following listed in the next question.
Yes, I give my consent for my camper(s) to be in the West Cook YMCA pool with Lifeguard and Swim instructor supervision as part of the Day Camp program. I understand that the use of the pool during this time may be with other members, and I consent to my child(ren) being in the pool during that time.I do NOT give permission for my child(ren) to be in the West Cook YMCA pool with lifeguard and Swim instructor supervision as part of the Day Camp program. I understand that the use of the pool during this time may be with other members, and I do NOT consent to my child(ren) being in the pool during that time.
If you do not give consent for emergency medical treatment as listed in previous question, please list what you do give the YMCA staff the authority to do:*
I approve as checked above and know the responsibility would rely on me for any medical costs that would come up. I give authorization based on the choices made above. *

Clear
Date of Signature*

MonthDayYear
Date

Health History Form
Family Physician's Name*

PrefixFirst NameLast Name
Physician's Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Physician's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Family's Dentist's Name*

First NameLast Name
Dentist Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Dentist Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Serious illnesses and/or hospitalizations. If more than one child, please label by child's name.*
Special physical conditions or disabilities that may require accommodations (please be specific) If more than one child, please list by child*
Yes, please send me the medical distribution form.No

Emergency Contacts

Emergency contacts will only be contacted in the case of a situation where we need to get a hold of parents/guardians and we have not been able to. Emergency contacts will also be allowed to pick up children from the program. If anyone other than those listed will be picking up your child, you must contact Youth Development Program Staff via daycamp@westcookymca.org. Phone authorization will not be sufficient. For the safety of your child, anyone picking up your child must have a picture ID. Anyone without proper authorization will not be allowed to take your child
Emergency Contact 1 Name*

First NameLast Name
Step-parentGrandparentAunt/UncleSibling (18 years or older)Cousin (18 years or older)Family FriendOther
Emergency Contact 1 Cell Phone*
Please enter a valid phone number.Format: (000) 000-0000.
YesNo

Emergency Contact 2 Name*

First NameLast Name
Step-parentGrandparentAunt/UncleSibling (18 years or older)Cousin (18 years or older)Family FriendOther
Emergency Contact 2 Cell Phone*
Please enter a valid phone number.Format: (000) 000-0000.

YesNo

Additional Authorized Pick-Up

All individuals who wish to pick up your child must be listed below, excluding parents and guardians listed under general information. If anyone other than those listed will be picking up your child, you must contact Youth Development Program Staff via daycamp@westcookymca.org. Phone authorization will not be sufficient. For the safety of your child, anyone picking up your child must have a picture ID. Anyone without proper authorization will not be allowed to take your child.
Additional Pick Up 1 Name*

First NameLast Name
Additional Pick Up 1 Phone *
Please enter a valid phone number.Format: (000) 000-0000.
Conditions for releasing child (if any)
YesNo

Additional Pick Up 2 Name*

First NameLast Name
Additional Pick Up 2 Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Conditions for releasing child (if any)
YesNo

Additional Pick Up 3 Name*

First NameLast Name
Additional Pick Up 3 Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Conditions for releasing child (if any)

Please submit your West Cook YMCA Day Camp enrollment form with a $25 nonrefundable deposit per week per camper to reserve your registration. The balance of your family's camp fees is due the Wednesday prior to start of each week your family is registered and we will contact you to set up auto draft of your family's fees.

If you have any questions, please do not hesitate to email us at daycamp@westcookymca.org. We will be responding to inquiries on Mondays and Wednesdays.

Enrollment confirmations will be sent every 2 weeks leading up to final registrations by July 30th

Please email, or drop off a copy of your child’s most recent copy of a physical. This will be need to be submitted by July 14th.
All fields for each child registration are completeMedical form is uploaded for each child registering for the program, or will follow up with email to daycamp@westcookymca.org by July 14 with most recent medical form for each child.
My Products*
prevnext( X )
Week 1: July 21-25
Deposit

$25.00 Quantity



Week 2: July 28- August 1
Deposit

$25.00 Quantity



Week 3: August 4-8
Deposit

$25.00 Quantity



Total

$0.00
Payment Methods

Fastlane Checkout

Choose from one of the PayPal options to make your payment.

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2025 West Cook YMCA Day Camp Enrollment Form

PARENT/GUARDIAN INFORMATION

PARENT/GUARDIAN INFORMATION (Cont.)

Child 1 Information

Child 2 Information

Child 3 Information

Child 4 Information

Family Information

Approval for West Cook YMCA Activities

Health History Form

Emergency Contacts

Additional Authorized Pick-Up