Family Camp Registration

Family Name*

To be used as a way to identify your family group on cabin signs, information packets, etc.

Primary Adult Full Name*

Primary Adult Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Primary Adult Phone*

Primary Adult Email*

Cabin Request

Please note that cabins will not be reserved until the $125 deposit is paid. Call Linda at 603-352-0447 to make a payment over the phone or mail a check to 32 Lake Street North Swanzey, NH 03431

Camper #1 Full Name

Camper #1 Age

Camper #2 Full Name

Camper #2 Age

Camper #3 Full Name

Camper #3 Age

Camper #4 Full Name

Camper #4 Age

Camper #5 Full Name

Camper #5 Age

Camper #6 Full Name

Camper #6 Age

Camper #7 Full Name

Camper #7 Age

Camper #8 Full Name

Camper #8 Age

Camper #9 Full Name

Camper #9 Age

Camper #10 Full Name

Camper #10 Age

Consent*

I agree to all YMCA Camp Takodah Policies and Procedures (including the cancellation and refund policy) and wish to enroll in Memorial Day Family Camp 2023.