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2015 YMCA Summer Camp
PERSONAL INFORMATION - One Child Per Registration
Father/Guardian Name:
Home Address:
Mother/Guardian Name:
City:
Father’s Cell/Work Phone:
/
Home Phone:
E-mail:
Zip:
Mother’s Cell/Work Phone:
Child’s Name:
Male
School:
State:
/
Female Birth Date:
Grade Completed at time of camp
Emergency Contact (other than parent or guardian):
Age:
(mm/dd/yy)
(at time of attendance)
Receive free/reduced School lunch Yes / No
______ Emergency Phone
Medical Information: All medications will be administered to the camper by the camp health coordinator. Children will not be allowed to take their
medication on their own. Specific written instructions must accompany the medication on the first day of camp.
Medical/Emotional Condition:
____________Allergies:
Medication:
____________
Bus Stop Location ( **Select from list on Page 2):
Please initial the activities you are allowing your camper to participate in. Any blanks indicate you do not want your camper
participating in those activities. This is your choice, and your camper is not required to participate in the activities listed below.
____ I have read the Horse Program liability release. I understand its contents and agree to its terms. I am further aware that I am releasing certain
legal rights. (all of Venture Vikes, Leif Ericson, Tepeetonka, and TLC campers)
_____I have read the High Ropes Program liability release. I understand its contents agree to its terms. I am further aware that I am releasing
certain legal rights. ( Tepeetonka and TLC campers)
_____I have read the Palisades climbing program liability release. I understand its contents agree to its terms. I am further aware that I am
releasing certain legal rights. (Tepeetonka and TLC campers)
I hereby consent to the participation of my child in the Sioux Falls YMCA Day Camp Program. I also, on behalf of my child, agree to indemnify and
hold harmless, the Sioux Falls Family YMCA from any claims, costs, damages, liabilities, or expenses resulting from injury to my child while in the
care, custody, or company, or company of the directors or staff members. I also give permission for the Sioux Falls Family YMCA to use any photographs or videos of my child for promotional purposes.
Parent/Guardian Signature: ___________________________________________________________ Date:________________________
How did you get information about Camp? Brochure in the mail _____ Brochure delivered at school _____ Went to the Downtown YMCA _____
Word of mouth/Friends _____ Computer/Email _____ Activities Fair _____ Other _______________________
Camp #1
Camp #2
Camp #V1
Camp #3
Camp #4
Camp #V2
Camp Session Dates for 2015
June 1 - 5 & June 8 - 12
Little
June 15 - 19 & June 22-26
Little
June 29 - July 3
July 6 -10 & July 13-17
Little
July 20 - 24 & July 27 - July 31 Little
Aug. 3 - Aug 7
Friend Request
Vikes _____ Leif Ericson _____ Tepeetonka _____ TLC _____
Vikes _____ Leif Ericson _____ Tepeetonka _____ TLC _____
Venture Vikes _____
Vikes _____ Leif Ericson _____ Tepeetonka _____ TLC _____
Vikes _____ Leif Ericson _____ Tepeetonka _____ TLC _____
Venture Vikes _____
PAYMENT INFORMATION
* We will do our best to place campers
with their friends.
Friend: __________________________
Friend:___________________________
PAYMENT WORKSHEET
Please
Circle
Age
Group
Downtown
YMCA
Family
Membership
Youth & Child
Member ship &
Family
Wellness
Membership
Little Vikes
4-5
$169.00
$199.00
$219.00
Leif Ericson (1-4)
6-9
$285.00
$315.00
$335.00
Venture Vikes (4,5)
6-9
$179.00
$189.00
$199.00
Tepeetonka
10-13
$315.00
$345.00
$365.00
TLC
14-15
$345.00
$375.00
$395.00
Camper Care
6-15
$40.00
$40.00
$40.00
Non-Member
Camp Fee:
Camper Care Fee :
Strong Kids Donation:
Total:
PAYMENT METHOD (Please Check One)
 Please note that a $100.00 non-refundable deposit is required.
 Final payment is due two (2) weeks before your camp start date.
 Applications for Scholarship are available upon request
TOTAL FEES $___________
Cash Check #__________ (Made payable to YMCA)
Credit card payment may be called in to the YMCA 336-3190
*****************OFFICE USE ONLY*************************
Amount Paid:$_________ Date Paid:________ YMCA Staff_______
2015 YMCA Summer Camp
Little Vikes (Ages 4-5): A unique introductory camping experience for
four and five year old boys and girls. Each day begins and ends at the
YMCA Camp Site (2301 E 26th St). In between, campers are transported
by bus to many different parks and places of interest. Our fantastic staff
offers safe and healthy outdoor activities and the caring and
understanding necessary for a well adjusted child.
Venture Vikes (Ages 6-9): This 5 day mini-camp is perfect for first
time day campers or for families with busy summer schedules. Campers
experience all of the traditional camp activities at their level and learn
about the world around them. While camp folklore and legends spark
their imaginations.
Leif Ericson (Ages 6-9): In a secure world, a child can run, play, and
make new friends. There are horses to ride, campfires to enjoy, and
stories to be told. Leif Ericson represents the foundation of the Sioux
Falls YMCA camping program. This is a child’s world where the spirit
moves through the leaves, grasses, and waters of the Big Sioux River.
Here the big city becomes an afterthought as campers get connected
with the outdoors.
Tepeetonka (Ages 10-13): Designed for the older camper, Tepeetonka
is a natural extension of the Leif Ericson experience. It recognizes the
changing needs for more adventure, more challenge, and more
accomplishment. These experiences become all the more meaningful
because they are shared with others. This is a distinctive camping
experience that has a reputation of instilling traditional values through
the example of a superb staff, inspirational campfire programs, opening
reflections each morning at chapel and off site experiences.
Tepeetonka Leadership Camp (Ages 14-15): This camp is designed
especially for fourteen and fifteen year olds. Tepeetonka Leadership
Camp or “TLC” will give these young adults the best of both worlds. A fun
and adventurous camping experience, mixed with the challenges of preparing to become a member of the staff.
Camper Care (Ages 6-15): Available before and after each Camp
Day at the YMCA Camp (2301 E. 26th St), for Leif Ericson,
Tepeetonka and TLC campers. Hours are 7:30 am - 8:30am and
4:00 pm - 5:30 pm. Camper Care fee is an additional $40.00 per child per
camp.
Camp Contact:
Mike Murphy - Camp Director
(605) 360-7414
[email protected]
Sarah or Abby (605) 336-3190
YMCA STRONG KIDS CAMPAIGN
Through the YMCA Strong Kids Campaign, your contribution
helps us provide program support and financial assistance to families
who need it in our community. Only by working together can we give
more kids the opportunity to grow strong in spirit, mind and body.
The school neither endorses or sponsors the organization or activity in this document. The
distribution of this material is provided as a community service. This organization is permitted
access to district facilities and services pursuant to the Equal Access Act and/or the Boy Scouts
of America Access Act.
Transportation
Little Vikes
Campers may be dropped off at the YMCA Camp (2301 E
26th St) between 7:30 am and 8:15 am and picked up
between 11:45 am and 12:15 pm.
Leif Ericson, Tepeetonka, and TLC
Campers will be picked up and dropped off daily at their
selected bus stop. Pick ups will take place between
7:00 am and 8:30 am and drop off will take place
between 4:00 pm and 5:30 pm. Specific times will be
mailed in your Informational Packet.
Bus Stop Locations
Sessions Offered
Anne Sullivan Elementary
1, 2, 3, 4
Cleveland Elementary
1, 2, 3, 4
Discovery Elementary
1, 2, 3, 4
Garfield Elementary
2, 4
Harvey Dunn Elementary
1, 2, 3, 4
Hayward Elementary
2, 4
Horace Mann Elementary
2, 4
All City at Jane Adams Elementary 2, 4
John F Kennedy Elementary
1, 2, 3, 4
John Harris Elementary
1, 2, 3, 4
Laura B Anderson Elementary
1, 3
Laura Wilder Elementary
1, 2, V1, 3, 4, V2
Longfellow Elementary
2. 4
Lowell Elementary
2, 4
Mark Twain Elementary
1, 2, 3, 4
Oscar Howe Elementary
1, 2, V1, 3, 4, V2
Pettigrew Elementary
2, 4
Robert Frost Elementary
1, 2, 3, 4
Rosa Parks Elementary
1, 3
Terry Redlin Elementary
1, V1, 3, V2
Axtell Park Middle
2, 4
Patrick Henry Middle
2, V1, 4, V2
West Side Family Wellness
1, 2, 3, 4
Wildflower Presb Church
1, 3
Central Baptist Church
1, 2, 3, 4
Embrace Church
1, 3
First Lutheran Church
1, 2, V1, 3, 4, V2
Linwood Wesleyan Church
1, 2, 3, 4
St Michael’s Catholic Church
2, 4
Tea Elementary
2, 4
Brandon Elementary
1, 3
Brandon–Fred Assam Elementary 1, 2, 3, 4
Brandon-Robert Bennis Elementary 1, 3
Harrisburg-Explorer Elementary
1, 2, 3, 4
Harrisburg-Endeavor Elementary 1, 2, 3, 4
Harrisburg-Freedom Elementary
1, 3
Harrisburg-Journey Elementary
1, 2, V1, 3, 4, V2
Harrisburg-Liberty Elementary
1, 3
To learn more about YMCA Camp
visit our Website and Facebook
www.siouxfallsymca.org
https://www.facebook.com/ymcacampleifericson
SIOUX FALLS FAMILY YMCA
220 S. Minnesota Ave. Sioux Falls, SD 57104