YMCA Camp Pinewood "Magic Steps to Growth"

2010 Alumni Registration August 6 - August 8

Fill out this form to register for a 2010 85th Anniversary Alumni Reunion. You may use the SUBMIT button to send this registration via e-mail or print it out and mail or fax it to Camp Pinewood. Fax number (231) 821-0487.
If you prefer you may call in your credit card information after submitting this registration form or mail a check.
Phone number (231)821-2421. Please call us after you submit with your intensions of payment.

Please register even if you are just stopping by for a few hours and not having a meal. We still want to make sure we know you are coming.

Your Information
*Alumni Full Name:
Previous Name:	(Maiden name or nickname while you were a camper)
*Address:
*City:	State: Zip: Country
*Home Phone:	Country Code (International phone #s only):
Daytime Phone:	Country Code (International phone #s only):
Cell Phone:	Country Code (International phone #s only):
*E-Mail Address:
2nd E-Mail Address:
Years attended Camp:	as a Camper
	as Staff

Lodging Information
I will be stopping by for a few hours without meals $0 (Please fill out any other appropriate sections below.)
Cabin (please check first choice) Adult Same Gender Cabin Family Cabin	Are you willing to share a cabin with another family or member Yes No If "Yes" please specifiy the family:
Tent Bringing Personal Tent Use of Camp Pinewood Tent
RV RV at CampPinewood with hook-up (Camp has two hook-ups on location, electric/water) RV at CampPinewood without hook-up (Plenty of room for non-hookups)
Offsite Accommodations (please specify) local Hotel local Camping
Date and Time of Arrival Friday Saturday Sunday Time:	Meals (check all that apply) Friday Dinner Saurday Breakfast Saturday Lunch Saturday Dinner Sunday Breakfast Sunday box lunch for the way home None just stopping by

Activities
	Activities we would like to do at camp: Please specify >	Suggest activities:
	I or a family member would like to lead an activity or volunteer in the kitchen, during the weekend. Please specify>	Lead Activity or volunteer:
	I or a family member would like to help plan or get ready for the reunion weekend.	Help plan or get ready:

Referrals

Here are other alumni names that we know (please specify below – Name, Address, Email, Phone
If you have a long list please email Diane at dszewczyk@ymcachgo.org

Campers Attending		Price	To Be Charged
Renunion Pricing
Great Price! Includes lodging, 6 meals, plus snacks and activities for the entire weekend. Price is person regardless of lodging. Children under the age of 6 attend free.
Please select the number of campers in your party by age.
	18 and over	Number of Campers x $15.00	$
	Ages 6-17	Number of Campers x $10.00	$
	Ages 5 and under	Child Campers FREE	$
Total			$
*Alumni preferring to bring their own tents, or RV or stay at offsite lodging pay the same price.

Camper Information

Please list all campers attending, ages and special consideration so appropriate programming can be planned. Children under the age of 5 attend free, but please do include them in the list of participants below.

Camper's Name Gender Age
Special Needs, Dietary Restrictions, Allergies
Please let us know of any special needs your family has while attending. This may include handicap accessibility, vegetarians, food allergies, etc.

Female
Male
Describe camper's needs here.

Female
Male
Describe camper's needs here.

Female
Male
Describe camper's needs here.

Female
Male
Describe camper's needs here.

Female
Male
Describe camper's needs here.

Female
Male
Describe camper's needs here.

Female
Male
Describe camper's needs here.

Female
Male
Describe camper's needs here.

Female
Male
Describe camper's needs here.

Female
Male
Describe camper's needs here.

Female
Male
Describe camper's needs here.

Female
Male
Describe camper's needs here.

Deposit/Refund Information and Health Release

PLEASE READ ALL OF THE FOLLOWING AND CHECK YES TO COMPLETE FORM:

Any applications submitted without payment information will be held and not processed until payment is received. Payment is requested at the time of registration please pay no later than 30 days prior to the reunion.

Cancellation refunds will be given up until two weeks prior to arrival. After this time there are no refunds available.

I/We approve this application and certify that the above are in good health and can attend camp.

I hereby authorize the Camp Health Officer to provide for and secure treatment of general health issues for the family named above. I understand that my family may be dismissed from the program if their behavior or actions are not in keeping with camp goals and policies. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by the camp director to hospitalize, secure proper treatment for, and to order injection, anesthetic, or surgery for the family named above. The YMCA does not furnish accident/illness medical insurance. Medical expenses, including prescription drugs, will be the responsibility of the parents or guardians.
The YMCA of Chicago has my permission to use photographs taken of my family while at camp for promotional purposes.

A waiver must be signed for each person that comes to the reunion. If you are bringing anyone under 18 please have the wiaver signed that is located in the form download section of this website.

* Yes, I or We (parents/guardians) have read and agree to the above statements.

Your Total

Total Amount: $

Payment is due 30 days prior to the reunion.

Thank you for your registration, we look forward to seeing you in August.

Note: This is NOT a secure site. We will not accept credit card information online,
please submit this form and call our office at 231-821-2421 with your credit card information.

YMCA Camp Pinewood
4230 Obenauf Road
Twin Lake, MI 49457

Fax:
(231) 821-0487

Phone:
(231) 821-2421