YMCA Summer Day Camp 2025- Holmen

YMCA Summer Day Camp 2025- Holmen

La Crosse Area Family YMCA: Ages 5-11
A $10.00 CANCELATION FEE WILL BE CHARGED FOR EACH CANCELED WEEK
Weekly payments will be due on the Monday of the week of camp. Cancelation Policy is at the end of this form.

COMPLETE ONE FORM FOR EACH CHILD
New or Returning?*

Returning to Summer (was enrolled in Summer Day Camp 2024 or currently enrolled in 2024/2025 School Age Care Program)New to Summer Day Camp
Child's Name (first & last)*
Child's DOB*

MonthDayYear
Date
Child's Gender*
Parent/Guardian Name:*
Parent/Guardian Email:*
example@example.com
Parent/Guardian Phone:*
Please enter a valid phone number.
Holmen Weeks of Day Camp
Below are the available Summer Day Camp locations. Please number your locations in order of enrollment preference.

* Prairie View
* Sand Lake
Select below the way you prefer your registration is entered if locations reach full capacity for your preferred location.*

Register my child by order of preference indicated (they will be registered in multiple locations and placed on the waiting list at preferred location)Register my child at one location throughout the summer (they will be placed on the waiting list for preferred location)
Weekly Rates: FT (4-5 days) $200.00 PT (1-3 days) $165.00
Week 1: June 2-6
Days of Attendance*

Full Time (4-5 days)Part Time (1-3 days)No Care needed
Week 2: June 9-13
Days of Attendance*

Full Time (4-5 days)Part Time (1-3 days)No Care needed
Week 3: June 16-20
Days of Attendance*

Full Time (4-5 days)Part Time (1-3 days)No Care needed
Week 4: June 23-27
Days of Attendance*

Full Time (4-5 days)Part Time (1-3 days)No Care needed
Week 5: June 30-July 3

(No care will be offered on Friday, July 4th)
Days of Attendance*

Full Time (4 days- no care Friday)Part Time (1-3 days)No Care needed
Week 6: July 7-11
Days of Attendance*

Full Time (4-5 days)Part Time (1-3 days)No Care needed
Week 7: July 14-18
Days of Attendance*

Full Time (4-5 days)Part Time (1-3 days)No Care needed
Week 8: July 21-25
Days of Attendance*

Full Time (4-5 days)Part Time (1-3 days)No Care needed
Week 9: July 28- August 1
Days of Attendance*

Full Time (4-5 days)Part Time (1-3 days)No Care needed
Week 10: August 4-8
Days of Attendance*

Full Time (4-5 days)Part Time (1-3 days)No Care needed
Week 11: August 11-15
Days of Attendance*

Full Time (4-5 days)Part Time (1-3 days)No Care needed
Week 12: August 18-22
Days of Attendance*

Full Time (4-5 days)Part Time (1-3 days)No Care needed
2025 SUMMER DAY CAMP PAYMENT AGREEMENT AND WAIVERS
Select 1 WEEKLY payment option:*

I receive WI Shares Subsidy. I will transfer monthly funds and receive an emailed invoice for out-of-pocket expenses.I prefer to receive an emailed reminder to make payment. My payments will not autodraft.I prefer to draft with an ACH.I prefer to draft with a Credit Card. A 3% processing fee will be charged with all credit card transactions.
*BANK DRAFT INFORMATION: Please verify this payment option is saved on your YMCA account.
Name of personal checking account holder:
Name of Bank:
*CREDIT CARD INFORMATION: Please verify this payment option is saved on your YMCA account.
Name on Credit Card:
Last 4 digits of card #:
WAIVERS AND AGREEMENTS

Please read and agree to the following statements:
I authorize you and the financial institution indicated to initiate electronic Debit entries to my account to be payable to the order of the La Crosse Area Family YMCA. I agree that your rights in respect to each such check shall be the same as if it were a check drawn on you and signed personally by me. The authority is to remain in effect until revoked by me in writing, and until you actually receive such notice I agree that you shall be fully protected in honoring any such check. I further agree that if any such check be dishonored, whether with or without cause and whether intentionally or inadvertently, you shall be under no liability whatsoever even though such dishonor results in the forfeiture of childcare.

Cancellation Policy: All cancellation requests must be made by the Monday, two weeks prior to the cancelled week and submitted via email to childcarebilling@laxymca.org. Any cancellation requests not meeting this criteria are required to pay the full cost of care for the week. Weekly care cancelations will be charged a $10.00 cancelation fee at the time of the cancelation.
1. I have read and agree to the YMCA Cancellation Policy*

Yes
2. I have read and agree to the YMCA Family Handbook Agreement and Release of Liability (located on Summer Day Camp Website)*

Yes
3. I have read and agree to the YMCA Photo and Video/Audio Recording Release Policy (located on Summer Day Camp Website)*

YesNo
Signature*

Clear
Date

MonthDayYear
Date
Should be Empty:

YMCA Summer Day Camp 2025- Holmen

Holmen Weeks of Day Camp

Weekly Rates: FT (4-5 days) $200.00 PT (1-3 days) $165.00

Week 1: June 2-6

Week 2: June 9-13

Week 3: June 16-20

Week 4: June 23-27

Week 5: June 30-July 3

Week 6: July 7-11

Week 7: July 14-18

Week 8: July 21-25

Week 9: July 28- August 1

Week 10: August 4-8

Week 11: August 11-15

Week 12: August 18-22

2025 SUMMER DAY CAMP PAYMENT AGREEMENT AND WAIVERS

*BANK DRAFT INFORMATION: Please verify this payment option is saved on your YMCA account.

*CREDIT CARD INFORMATION: Please verify this payment option is saved on your YMCA account.

WAIVERS AND AGREEMENTS