QYU Summer Camp 2024 Registration Form

QYU Summer Camp 2025 Registration Form

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

Select all the CAMP(S) you would like to register for (you can select multiple):*

July 7-18 - Masterpiece (Belleville) - COST $250Aug 5-8 - Masterpiece (Napanee) - COST $125Aug 11-15 - Masterpiece (Quinte West) - $125Aug 11-15 - Graphic Word DM Training Camp (Belleville) - COST $55Aug 25-29 - Graphic Word RPG Camp (Belleville) - COST $55

Youth Name*

Birthday:*

MonthDayYear

T-Shirt Size*

School grade in September 2025:*

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

Do you give Quinte Youth Unlimited staff and volunteers permission to act on your behalf in the event that medical attention is needed?*

YesNo

Do you give Quinte Youth Unlimited staff or volunteers to take pictures and/or video of your child for the purpose of highlight reels newsletters, website or print promotions?*

YesNoOther

Any other comments or questions?

How will you be paying?*

Total cost for camp registration

Amount

*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

E-TRANSFER TO QYU:

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 YOU CLICK SUMBIT, COMPLETE YOUR E-TRANSFER THROUGH YOUR BANK

PAYING WITH CASH OR CHEQUE

CASH or CHEQUES can be GIVEN a QYU camp leader before camp begins.

CASH or CHEQUES can be DELIVERED to the QYU office during regular business hours (please call before arriving) at 444 Dundas St West, Belleville

CHEQUES can be MAILED to the QYU office at P.O. Box 233, Belleville ON K8N 5A2

AFTER SUMITTING, 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