2024-25 Winter New Horizons Day Camp

YMCA Membership Verfication

I/We are YMCA member:*

YMCA General Membership is a one-time lifetime payment of $50.00 which covers all household members. It is not willable; non-refundable. Minors who are ward of the State in foster care/guardianship shall establish individual YMCA membership. This will allow the YMCA membership to follow the minor should they transfer foster care/parents. Register online or call 808-935-3721 to check on YMCA General Membership.

Yes

No

You must have a current YMCA Lifetime membership for your household in order to enroll in YMCA programs. YMCA Membership is $50 for lifetime and covers all family members in your household. To become a YMCA member, enroll online, click here

After you have your YMCA membership, please continue to complete the application for the camp application below. YMCA membership does not guarantee acceptance into YMCA camp and summer programs.

Returning Camper*

Has this participant attended camp at Island of Hawaii YMCA before? There is a one-time $25 fee for first time campers.

Yes, Returning Camper

No, First Time Camper

Session*

Please select dates of attendance.

Session 1: Dec. 23 - 27

Session 2: Dec. 30 - Jan 3

Session 3: Dec. 23 - Jan 3

Daily Drop-In ($55/day)

Total

Includes session cost and fees

Total Drop-In Days*

How many days will you drop-in?

Please enter a number greater than or equal to 1.

Weeks

Cost

Camp Cost

Application Fee

$25 application processing fee for first time campers only

Price:

Water bottle fee

Mandatory water bottle fee of $1 per day. Your child will receive a bottle of water DAILY upon arrival. Refills are provided throughout the day.

Price: $1.00

Water bottle fee

Mandatory water bottle fee of $1 per day. Your child will receive a bottle of water DAILY upon arrival. Refills are provided throughout the day.

Price:

Water bottle fee

Mandatory water bottle fee of $1 per day. Your child will receive a bottle of water DAILY upon arrival. Refills are provided throughout the day.

Price:

Total Cost

We will contact you for payment after review and confirmation of your application. Tuition must be paid in full prior to start of camp. Payment options available.

Payment via Credit Card will include a 3.5% processing fee

This field is hidden when viewing the form

Financial Assistance Needed?*

Island of Hawai‘i YMCA can provide financial assistance based on need and availability. If you indicate Yes, the next section will request details of your financial situation. Please be prepared to write a detailed letter of hardship elaborating your situation.

Yes

No

YMCA Financial Assistance is not available for the Fall or Winter session.

Child Care Connection

The State of Hawaii Child Care Connection Hawaii (CCCH) subsidy program helps low-income families to sustain their employment, educational efforts and job training by paying a subsidy for their children who are in the care of DHS-approved child care providers. Visit the DOHS site for more information on criteria and application.

Are you eligible for Child Care Connection?*

Please understand that we must receive payment before childcare is given. It is up to you to provide verification for the Child Care Connection Program. All CCC applications must be signed by the YMCA 60 days prior to the start of camp.

Yes

No

Financial Assistance Application

Parent/Guardian Name*

First Last

Address*

Mobile Phone*

Home Phone

Email*

Employment Status*

Employed

Unemployed

Self Employed

Student

Current Employer

Occupation

Monthly Salary/Wages/Tips*

Hours Worked per Week*

Other Sources of Income*

Household Size*

If unemployed, please explain how you support yourself financially*

If unemployed and receiving unemployment insurance compensation, when does this end?*

Is there anything else we need to know about your financial situation?

Personal Statement of Hardship*

*** NOTICE: *** Generic statements of hardship will be rejected. Only DETAILED statements including why financial assistance is sought will be reviewed. Statement should include how receiving financial assistance will help your family situation and the impact it will make on your child.

Required Documentation*

Please bring or mail a copy of the following to the YMCA to complete your application.

Driver’s License or State ID

Previous year tax return or last 2 months of paystubs

Verification of DHS Assistance (if applicable)

Our financial assistance program serves individuals and families who show financial hardship. A portion or all of the membership dues may be waived for a limited period of time once it is reviewed by the YMCA & the CEO. Completed application & required documentation may be delivered to our office at 300 W. Lanikaula Street, Hilo, HI 96720

Parent/Guardian 1

Parent/Guardian 1 Name*

Parent/Guardian 1 Email*

Parent/Guardian 1 Cell Phone*

Parent/Guardian 1 Work Phone

Parent/Guardian 1 Place of Employment*

Parent/Guardian 1 Relationship*

Parent/Guardian 2

Parent/Guardian 2 Name

Parent/Guardian 2 Email

Parent/Guardian 2 Cell Phone

Parent/Guardian 2 Work Phone

Parent/Guardian 2 Place of Employment

Parent/Guardian 2 Relationship

Emergency Contacts*

Please list at least 2 contacts. (IN ADDITION TO THE PARENTS/ LEGAL GUARDIANS, I AUTHORIZE ONLY THE FOLLOWING PEOPLE TO PICK UP MY CHILD AND/ OR IN AN EMERGENCY, BE CONTACTED IF THE PARENT/ LEGAL GUARDIAN CAN'T BE CONTACTED.)

Full Name

Relationship

Cell Phone

Work Phone

Releases & Waivers

YMCA COMMITMENT:

Upon review and approval of your application, the YMCA will reserve your child’s spot in camp and guarantee childcare once payment and Y membership is established.

Camp Information

Camp Hours: 6:30am -5:30 pm
Breakfast, Lunch, and 2 snacks included
If your child requires a special diet, you must provide it. If you bring home lunch please remind child NO SHARING
Bring a flask with water daily, refills available
Label child's belongings (water flask, backpack, etc.)
Child must be potty trained

No Participation, No Play
Journal Writing, Arts & Crafts
Organized physical activities
Drama, Cultural dancing
Calming Environment
Learning Center 1 Hour daily
Cursive Writing

Current Photo*

Please provide a current portrait photo of your child.

Accepted file types: jpg, Max. file size: 6 MB.

Birth Certificate or Proof of School Enrollment file upload*

Proof of school enrollment includes acceptance letter or a current report card.

Accepted file types: jpg, jpeg, png, pdf, Max. file size: 6 MB.

PLEASE ATTACH ONE OF THE FOLLOWING TO YOUR APPLICATION:

Child's birth certificate
Proof of attendance at any public or private school
Letter of acceptance to any public or private school

Parent/Guardian Name*

Child's Name*

Submitter's Email*

Signature

You must have a current YMCA Lifetime membership for your household in order to enroll in YMCA programs. YMCA Membership is $50 for lifetime and covers all family members in your household. To become a YMCA member, enroll online, click here

After you have your YMCA membership, please continue to complete the application for the camp application below. YMCA membership does not guarantee acceptance into YMCA camp and summer programs.

2024 Winter New Horizons Camp Application

YMCA Membership Verfication

Cost

Child Care Connection

Financial Assistance Application

Participant Information

Parent/Guardian 1

Parent/Guardian 2

Medical

Releases & Waivers

YMCA COMMITMENT:

Camp Information