Clone of BTYP Registration Form 2025

Belle Terre Youth Program Summer Camp Registration 2026
Camper Information
Camper Name

First NameLast Name
Date of Birth
Grade 2026-2027 School Year
Shirt Size
Parent/Guardian Information
Parent/Guardian Name

First NameLast Name
Phone Number
Format: (000) 000-0000.
E-mail
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Session Choices

Select your camper's session from the options below.

Be sure to choose the session option based upon your residency - "Belle Terre Resident" or "Other Resident."

Use the drop down menu to select which # child you are registering (Fees are discounted for each additionally registered child).

This section indicates how much your registration fee is for this camper only. If you are registering more than one child, you may make one total payment for all campers. Be sure to make your payment through the AllPaid website (link also available on Registration Information Page).
prevnext( X )
Full Day (Belle Terre Resident)
9 a.m. - 4 p.m.; 1st - 8th grade; Includes lunch supervision

$1,100.00 Quantity



Full Day (Other Resident)
9 a.m. - 4 p.m.; 1st - 8th grade; Includes lunch supervision

$1,525.00 Quantity



Half Day AM ONLY (Belle Terre Resident)
9 a.m. - 12 p.m.; 1st - 9th grade

$675.00 Quantity



Half Day AM ONLY (Other Resident)
9 a.m. - 12 p.m.; 1st - 9th grade

$950.00 Quantity



Half Day PM ONLY (Belle Terre Resident)
1 p.m. - 4 p.m.; Pre K - 8th grade

$675.00 Quantity



Half Day PM ONLY (Other Resident)
1 p.m. - 4 p.m.; Pre K - 8th grade

$950.00 Quantity



Lifeguarding (Belle Terre Resident)
9 a.m. - 12 p.m.; Red Cross certification course; MUST be 15 yr old to earn the certification; May attend the class 10th grade & up; Includes $100 equipment fee & lunch supervision

$675.00 Quantity



Lifeguarding (Other Resident)
9 a.m. - 12 p.m.; Red Cross certification course; MUST be 15 yr old to earn the certification; May attend the class 10th grade & up; Includes $100 equipment fee & lunch supervision

$900.00 Quantity



Junior Counselor
12 p.m. - 4:15 p.m.; Must be 9th or 10th grade registered AM camper; Includes lunch supervision; Earn community service helping younger campers

Free Quantity



Total

$0.00

Medical & Emergency Contact Information
Camper Name

First ameLast Name
Date of Birth
Parent/Guardian Name
Phone # in Case of Emergency
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Additional Emergency Contacts

In addition to parent/guardian, include TWO additional emergency contacts

Rows	Name	Phone #	Relationship
1
2

Immunizations

Dates of immunization for each must be provided. Dates will be reviewed by a medical professional to be sure they are accurate and up-to-date.

Rows	Vaccination Dates
DTap (diphtheria, tetanus, pertusseis
Hib (haemophilus influenza type b)
Hepatitis B
MMR (measles, mumps, rubella)
IPV (poliomyelitis)
Varicella (chickenpox)

Additional Medical Information
Physician's Name
Physician's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Does the camper have any of the following?
Allergies
(If yes, please explain)
Hearing/vision concerns
(If yes, please explain)
Major organ concerns
(If yes, please explain)
Special needs
(If yes, please explain)
Other
(If yes, please explain)
Signature
Date

MonthDayYear
Date

Evacuation
During the course of the summer, there is occasional inclement weather. Severe weather, such as lightning, necessitates the beach to be closed. We are then required to evacuate the beach. Unfortunately, severe weather may begin after a session starts. In these cases, we must remove the campers from the beach and transport them to the Community Center as quickly as possible for immediate pickup. Campers will be transported in an orderly fashion by our staff and, if necessary, by available parents. You are welcome to come to the beach to pick up your child.

Photographs
The Youth Program will be taking pictures of your child, both in a posed group shot and in candid photographs during camp activities so that we may provide you with lasting memories of the summer.
Use of insect repellent

Written permission of a parent or guardian shall allow a camper to carry and use insect repellent. A child unable to physically apply insect repellent may be assisted by unlicensed personnel when directed to do so by the camper, if permitted by a parent or guardian and authorized by the camp. (New York State Public Health Law)
Suffolk Co. Dept. of Health Services Camp Operator Permit Information

New York State requires that Parents or Guardians be notified that:
1. The Camp must have a permit to operate from the Suffolk County Dept. of Health Services.
2. The Camp is required to be inspected twice yearly.
3. The inspection reports & required plans are filed & available for review at the Suffolk County Dept. of Health Services, 360 Yaphank Ave., Suite 2A, Yaphank, NY 11980.
Signature
Date

MonthDayYear
Date

NEW OPTION THIS YEAR

Pay a $200 deposit per registration now to hold your spot and pay your balance later! Balances paid before June 1st will get the Early Bird Registration rates
Which payment option are you going to proceed with ?
IMPORTANT:

PLEASE READ

When you click the CONTINUE button, you will be redirected to the AllPaid so you can conveniently pay your registration fee online.

You may wait to make your payment until all of your campers have been registered.

You are NOT REQUIRED to pay through All Pay. You may submit payments by check:

Belle Terre Village Office

1 Cliff Rd.

Belle Terre, NY 11777
Should be Empty:

Belle Terre Youth Program Summer Camp Registration 2026