NYYM Summer Sessions Registration for JYM
One Person Under 18 Years Of Age
Silver Bay YMCA, Silver Bay, NY  July 18–24, 2010
BEFORE July 12 return to: NYYM, 15 Rutherford Place, New York NY 10003
AFTER July 12 send to: Silver Bay YMCA of the Adirondacks, 87 Silver Bay Rd.,
Silver Bay NY 12874; 518-543-8833
PLEASE PRINT
Name  ____________________________  Meeting _________________
Age now ____________________	Grade in fall ___________________
Address __________________________________________________
City  ______________________  State ____________  Zip _________
Day phone (_____ ) __________   Evening phone (_____ ) ___________
E-mail address _____________________________________________  
Arrival day & date ___________ Departure day & date ___________
Fee enclosed (see fee chart) $ ______________________________
July address, phone, if other than above:  Address__________________
City  ____________ State ____  Zip _____ Phone (___) __________ 
Check all that apply:  
__ Female __ Male __ Vegetarian __ First time at YM/JYM
Special needs:  __ hearing    __ seeing   __ walking    __ other: ___________
Sponsor at YM if other than parent/guardian: _______________________________________________________
Grades 10, 11, & 12 Worship Group choice _____________________
 (Worship groups are listed on the adult registration form.)
Silver Bay YMCA Housing: 
 __ I prefer the same room assignment as last year
First choice __________________________ Rate: $ __________
Second choice ________________________ Rate: $ __________
 __ If neither is available, location is more important
 __ If neither is available, price is more important
 __ Please assign me a roommate _______________________________
Name of parent/sponsor/other roommate __________________________
I will cluster with  __________________________________________
I will stay off-campus at (name/address) _________________________
 __All meals    Only these meals: ____________________________
Application to NYYM for financial assistance (due 6/25/10)
Source of funds: 	Private 	$ ____________
	Provided by monthly/regional meeting 	$ ____________
	Requested from Equalization Fund* 	$ ____________
	*letter from monthly meeting clerk recommended
By submitting this form, I acknowledge that I have read the NYYM agreements.