Name of Child #1
Is Child #1 YMCA Member?
Has Child #1 Attended Camp Before?
Name of Child #2
Is Child #2 YMCA Member?
Has Child #2 Attended Camp Before?
Name of Child #3
Is Child #3 YMCA Member?
Has Child #3 Attended Camp Before?
Address
Parent/Guardian #1 Name
Parent/Guardian #2 Name
Has your family received financial assistance this year for a YMCA program?
Work status of Adult #1 in household:
Work status of Adult #2 in household: