Junior YM & Youth Registration

WYM Jr and Young Friends Registration

All children and youth must pre-register in order to participate in WYM Annual Sessions programming.
All registrations must be received by July 1, 2012 to be considered pre-registered. Please fill out a separate Registration Form for each child attending.

Each child/youth have a separate Permission/Medical Forms to participate in WYM programming and have a parent/guardian signature. These forms can be found at www.westernym.net or through the WYM office.

Child's Name
First Last
Age of child
Gender

Male

Female
Child's Grade Level
Parent / Guardian
First Last
Home Meeting
Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Family Phone
### - ### - ####
Family Email Address
For Nursery Care

If your child is Nursery Age (Preschool and younger), please fill out the following section.

The nursery will be located in the Plainfield Friends nursery. The cost covers childcare and snack. It does not include meals. Please check the $8.00 box if childcare is needed that day. Check AM if childcare is needed in the morning. Check PM if childcare is needed in the afternoon. Check evening if childcare is needed in the evening. Cost is $8.00 if childcare is needed for any part of the day.
Thursday

$8.00 for the day

AM Childcare needed

PM Childcare needed

Evening Childcare needed
Friday

$8.00 for the day

AM Childcare needed

PM Childcare needed

Evening Childcare needed
Saturday

$8.00 for the day

AM Childcare needed

PM Childcare needed

Evening Childcare needed
Sunday

$8.00 for the day

AM Childcare needed

PM Childcare needed

Evening Childcare needed
Total for Nursery
$ Dollars . Cents
For Jr. Friends

Please fill out the following section if your child is K-5th Grade.

Cost is $20 per day or $75 it they are staying the whole 4 days. This includes programming, snacks and meals.
Please check the Staying all 4 days box if the child will be there all 4 days.
If not, check the boxes corresponding to the days the child will be there.

Staying all 4 days ($75.00)

Thursday ($20.00)

Friday ($20.00)

Saturday ($20.00)

Sunday ($20.00)
Total for Jr Friends
$ Dollars . Cents
For Young Friends

Please fill out the following section if your child is 6th-12th grade.

Cost is $85 for all 4 days. This cost includes housing, programming and all meals. No daily rates available.
Thursday-Sunday Young Friends YM
$ Dollars . Cents
Total Registration Due
$ Dollars . Cents
Please send payment to Western Yearly Meeting. Each child will also need a Medical / Permission form filled out and signed by a parent/guardian. That form can be found at www.westernym.net or through the YM office.

Western Yearly Meeting
203 S. East St. Plainfield, IN 46168

For Nursery Care

For Jr. Friends

For Young Friends

Please send payment to Western Yearly Meeting. Each child will also need a Medical / Permission form filled out and signed by a parent/guardian. That form can be found at www.westernym.net or through the YM office.