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THE YOUTH CENTER - REGISTRATION FORM
Required paperwork must be picked up at The Youth Center, completed
and returned prior to the start of any program. All payment is due in full upon
registration. No postdated or partial payments will be accepted.
NO REFUNDS OR CREDITS GIVEN FOR ANY REASON.
PLEASE COMPLETE
EVERY LINE.
Please print out page and fill out one per camper and mail to:
The Youth Center / P.O. Box 92 / Glen Gardner, NJ 08826
Childs Name
_________________________ Nickname_____________________
Allergies/Restrictions:
_______________________________________________
Home Phone ________________ Age:________
Birthdate__________________
Parents/Guardians Names: ___________________________________________
Work Phone # ____________________ Cell Phone
#:_____________________
Mailing Address
____________________________________________________
City/State
__________________________________ Zip ___________________
Street
Address
____________________________________________________
Town/Township____________________
County _________________________
PROGRAM
REGISTRATION
Course Title
______________________________________________________
Start Date
_______________________ Location ________________________
Day of Class
______________________ Time of Class ___________________
Public school child attends or will be attending
__________________________
I do  / I
do not consent
that photos/videos of myself and my child are the property of
The Youth
Center and may be reproduced and publicized as The Youth Center
desires,
free of any claim on my part.
I understand, agree and
consent to all terms and conditions as described in the registration
information/brochure including payment requirements . I understand ALL
MONIES are non-refundable for any reason.
Parent Signature
___________________________________Date _____________
For purposes of corporate funding, please provide parents'
Places of Employment
Mother__________________________
Father______________________________
PAYMENT REQUIREMENTS
I. PRESCHOOL AND KARATE
| Amount Due: Tuition $ _________ x 2 (First & Last Month)
= |
$
____________ |
| +
Annual Individual Membership Fee (if not current): |
$ 25.00 |
|
= Amount of this Payment |
$
____________ |
II. SPORTS
| Program Fee: $
_________ + $25.00 Membership (if not current) = |
$ ____________ |
III. CAMP REGISTRATION: Please check weeks and programs desired:
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WEEK |
DATES |
CAMP |
MINI CAMP |
BEFORE CARE |
AFTER CARE |
BUS TRANS. |
| 1 |
June 19 - June 23 |
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| 2 |
June 26 - June 30 |
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| 3 |
July 3
- July 7 |
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| 4 |
July
10 - July 14 |
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| 5 |
July
17 - July 21 |
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| 6 |
July
24 - July 28 |
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| 7 |
July
31 - Aug. 4 |
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| 8* |
Aug. 7 - Aug. 11 |
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| Post 9* |
Aug. 14 - Aug. 18 |
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| Post 10* |
Aug 21 - Aug.25 |
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* Must enroll in at least one
other week (between 1-7) to enroll in Week 8 and/or EITHER Post
Week.
Specialty Camps for 2006 are as
follows; dates have not yet been established:
Please check Specialty Camps
if interested: Soccer Dance Teen Camp
T-Shirt Size:
Child-MD Child-LG Adult-SM Adult-MD Adult-LG
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CAMP PAYMENT OPTIONS: (choose
one)
Payment Option A
|
# Weeks __________ x $50.00 per week
non-refundable deposit |
$ ____________ |
|
+ Annual Individual Membership Fee (if not current): |
$ 25.00 |
|
= Amount of this Payment |
$ ____________ |
Payment Option B
Monthly Installment Plan (MIP) Not available after May 1,
2006.
# of Weeks ________________ Deposit required $
_______________
IV. CAMPFIRE FRIDAYS
REGISTRATION (please check below)
February 3
April
7 FREE
No confirmation will be mailed. Unless otherwise
noted, please report to first class. Use a separate form – or plain paper
– for each registration. Mail payments to P.O. Box 92 Glen Gardner, NJ
08826 and call with any questions (908) 537-4594.
The Youth Center is a United Way Member
Agency.
The Youth Center reserves the right to cancel
sessions with insufficient enrollment and credit or refund any payments already
received. Not responsible for typographical errors or errors of omission. The
Youth Center reserves the right to make changes or alterations as deemed
necessary. |
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