Registration for MYC 2024 Summer Camp

Registrations due FRIDAY JUNE 21, 2024 by 1 PM

The registration form follows. Please be sure it is filled out before following any links on this page.

Once registered, an MYC staff member will be in contact to confirm enrollment. If a waitlist is created due to limited space, the Milford Youth Center will contact families in the order of enrollment date, as space becomes available.

Camp runs from 8 am to 4 pm Monday through Friday, with an extended day option until 5 pm.

To reserve your child's spot:

$60 deposit per week of camp you want them to attend;
Milford Residents $175 per week;
Non-Milford Residents: $190 per week;
Single Day Fee: $75 per day;
Extended Day until 5 pm: $20 per day

Since space is filling up so quickly, MYC Staff will contact you to tell you about payment in the confirmation email.

We will be able to have off site field trips and our calendar is available here.

FYI: T-shirt exact size request is not guaranteed

Participant information

Child's Name: *

Child's Birthdate * +

T-shirt size? *

Gender *

Race: *

Ethnicity: *

Hispanic or Latino

Not Hispanic or Latino

Prefer not to answer

Does Your Child Receive Free Lunch?: *

Free Lunch

Reduced Lunch

Neither

Prefer Not to Answer

Primary Language

Secondary Language

Pronouns *

Please classify your childs swim experience (Please note that most field trips and weekly activities include water and any non-swimmers will only be allowed in the water up to their knees for safety purposes.) Any municipal or private pools the MYC will be visiting during camp will conduct a swim test on all swimmers, as it is standard protocol. *

Non-Swimmer

At Risk Swimmer

Swimmer

Do you need to register a second child? *

Yes

No

2nd Child's Name:

Child 2's Birthdate +

T-shirt size? *

Gender *

Race: *

Ethnicity: *

Hispanic or Latino

Not Hispanic or Latino

Prefer not to Answer Prefer not to Answer

Does Your Child Receive Free Lunch?: *

Free Lunch

Reduced Lunch

Neither

Prefer Not to Answer

Primary Language

Secondary Language

Pronouns *

Please classify your childs swim experience (Please note that most field trips and weekly activities include water and any non-swimmers will only be allowed in the water up to their knees for safety purposes.) Any municipal or private pools the MYC will be visiting during camp will conduct a swim test on all swimmers, as it is standard protocol. *

Non-Swimmer

At Risk Swimmer

Swimmer

Do you need to register another child? *

Yes

No

3rd Child's Name:

3rd Child's Birthdate +

T-shirt size?

Gender *

Race: *

Ethnicity: *

Hispanic or Latino

Not Hispanic or Latino

Prefer not to Answer Prefer not to Answer

Does Your Child Receive Free Lunch: *

Free Lunch

Reduced Lunch

Neither

Prefer not to Answer

Primary Language

Secondary Language

Pronouns *

Please classify your childs swim experience (Please note that most field trips and weekly activities include water and any non-swimmers will only be allowed in the water up to their knees for safety purposes.) Any municipal or private pools the MYC will be visiting during camp will conduct a swim test on all swimmers, as it is standard protocol. *

Non-Swimmer

At Risk Swimmer

Swimmer

Do you need to register another child? *

Yes

No

4th Child's Name:

4th Child's Birthdate +

T-shirt size?

Gender *

Race: *

Does Your Child Receive Free Lunch?: *

Free Lunch

Reduced Lunch

Neither

Prefer not to Answer

Ethnicity: *

Hispanic or Latino

Not Hispanic or Latino

Prefer not to Answer Prefer not to Answer

Primary Language

Secondary Language

Pronouns *

Please classify your childs swim experience (Please note that most field trips and weekly activities include water and any non-swimmers will only be allowed in the water up to their knees for safety purposes.) Any municipal or private pools the MYC will be visiting during camp will conduct a swim test on all swimmers, as it is standard protocol. *

Non-Swimmer

At Risk Swimmer

Swimmer

Parent/Guardian First Name *

Parent/Guardian Last Name *

Email Address *

Phone Number *

Street Address *

Address Line 2

City *

State *

Zip Code *

Mobile Phone Number *

Photo Release

I understand that my child(ren)’s name and photo may be used in photographs, videos, literature, web pages, and news releases in local papers and other media outlets. I, the aforementioned Parent/Guardian, give permission for my son/daughter(s) to be photographed and named for MYC Summer Camp for the Milford Youth Center. *

Yes

No

Signature for Photo Release *

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Therapy Dog in Training Waiver

I, the parent or guardian of the student in this form give permission for my child(ren) to interact with Cora, the therapy dog in training, and accept full liability in the event that Cora causes accidental injury to my child in any way throughout the course of the activity. Furthermore, I am not aware of any fear, allergy, skin or respiratory sensitivity, or other medical condition my child(ren) has/have that would render physical interaction (i.e., touching, handling) with or close proximity to a dog potentially harmful to his or her health. *

Yes, I give permission for my child to interact with Cora

No, my child is allergic, scared of dogs, or for another reason cannot interact with Cora

Signature for Therapy Dog Release *

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MYC Summer Camp

This does not guarantee your child has a spot. A Milford Youth Center staff member will be in touch to confirm your registration.

DISCLAIMER: Please reference the summer camp calendar before signing your child up for certain feild trips. Please ensure that your child will particpate in the feild trip actvties (ex. rollercoasters, rides and waterslides) before slecting the date. The Milford Youth Center does not suggest that parents sign their child up for feild trips if their child will not particpate!

Dates Requested *

	Monday	Tuesday	Wednesday	Thursday	Friday	None
Week 1 of Monday July 8 - Friday July 12	Monday	Tuesday	Wednesday	Thursday	Friday	None
Week 2 of Monday July 15 - Friday July 19	Monday	Tuesday	Wednesday	Thursday	Friday	None
Week 3 of Monday July 22 - Friday July 26	Monday	Tuesday	Wednesday	Thursday	Friday	None
Week 4 of Monday July 29 - Friday August 2	Monday	Tuesday	Wednesday	Thursday	Friday	None
Week 5 of Monday August 5 - Friday August 9	Monday	Tuesday	Wednesday	Thursday	Friday	None
Week 6 of Monday August 12 - Friday August 16	Monday	Tuesday	Wednesday	Thursday	Friday	None

Do you need Extended Day from 4pm -5pm on any days? *

Yes

No

Extended Days 4pm-5pm *

	Monday	Tuesday	Wednesday	Thursday	Friday	None
Week 1 of Monday July 8 - Friday July 12	Monday	Tuesday	Wednesday	Thursday	Friday	None
Week 2 of Monday July 15 - Friday July 19	Monday	Tuesday	Wednesday	Thursday	Friday	None
Week 3 of Monday July 22 - Friday July 26	Monday	Tuesday	Wednesday	Thursday	Friday	None
Week 4 of Monday July 29 - Friday August 2	Monday	Tuesday	Wednesday	Thursday	Friday	None
Week 5 of Monday August 5 - Friday August 9	Monday	Tuesday	Wednesday	Thursday	Friday	None
Week 6 of Monday August 12 - Friday August 16	Monday	Tuesday	Wednesday	Thursday	Friday	None

It is recommended that campers should bring sunscreen every day. In the case that they do not have any, is it okay for your child to use MYC supplied sunscreen? *

Yes! My camper can use any sunscreen

No! My camper has allergies and/or they otherwise CANNOT use another sunscreen

As part of summer camp, we are able to provide breakfast and lunch to the students. While we will check on a day to day basis, it is helpful to have a rough estimate of the number of meals that will be needed.

Would you like to sign your child up for breakfast? *

Yes, my child will have breakfast at camp

No, my child will have breakfast at home

Would you like to sign your child up for lunch? *

Yes, my child will have a camp lunch

No, my child will bring lunch from home

Emergency Contacts and Authorized Pickups

In the event that you are unable to pick up your child at the end of the day or unable to be contacted in the event of an emergency, we need names and phone numbers of authorized pickups and emergency contacts. Please fill out their information here. We will be asking for an ID at pickup.

Should you need to add, remove, or otherwise alter authorized pickups and/or emergency contacts during the program, we require a written and signed note from the parent/guardian

Emergency Contact Full Name *

Emergency Contact Phone Number *

Emergency Contact 2 Full Name

Emergency Contact 2 Phone Number

I give permission for my child to walk home at 4pm without being picked up by an authorized adult *

Yes

No

Authorized Pickup Full Name *

Authorized Pickup Phone Number *

Authorized Pickup 2 Full Name

Authorized Pickup 2 Phone Number

Authorized Pickup 3 Full Name

Authorized Pickup 3 Phone Number

Authorized Pickup 4 Full Name

Authorized Pickup 4 Phone Number

Any additional Authorized Pick ups and their phone numbers

I understand the Milford Youth Center Pick Up Policy. Pick Up Policy linked here. *

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MYC Code of Conduct

MYC Code of Conduct:

The Milford Youth Center Code of Conduct prohibits the following activities for all participants and their parents, guardians, and/or caretakers:

Possession and/or use of alcoholic beverages, tobacco and illegal substances (including vaping and E-cigarettes);
Sexual or physical misconduct and/or harassment;
Possession of weapons or firearms;
Use of foul language or profanity (including on clothing/belongings);
Appropriate use of all technology (personal and MYC property);
Behavior that violates state, local laws, school or facility rules and regulations.

The Milford Youth Center Code of Conduct requires and considers mandatory the following activities for all participants and their parents, guardians, and/or caretakers:

Observance of all facility rules and regulations;
Completed and signed conduct and liability forms;
Signing in and out of the center with MYC key tag or ID number;
Participants must be picked up by closing of After School Program (unless they are walkers). Three tardy pickups will result in a “strike” violation;
There is no loitering in front of the MYC property unless students are waiting to enter and/or to be picked up;
All are responsible for their own personal belongings. All lost and found items without names on them are donated and/or recycled (water bottles) at the end of each month as it accumulates quickly! Please remind your child/participant to check daily as they exit;
Reporting of conduct violations by all participants: The Milford Youth Center Code of Conduct requires that all members respect the property and personal boundaries (ex. No bullying of either a physical or verbal nature) of others and the staff members in which any Milford Youth Center sponsored activity is held. Misuse or damage of any equipment and/or property is the responsibility of the parent and/or guardian.

Cameras are in use at all times

We utilize local law enforcement for any violations in building or on grounds

Discipline:

If these rules are broken the Milford Youth Center adheres to the three- strike policy (discretion of Youth Center staff based on the severity of issue):

First Strike: MYC member is expelled from the Center for one day and parent/guardian is notified.
Second Strike: MYC member is expelled for one week. Parent/guardian is notified and must meet with Youth Center staff before member is accepted back into the Center.
Third Strike: MYC member is expelled indefinitely or a period of time that is deemed appropriate by the Youth Center staff. Parent/guardian is notified and must meet with Youth Center staff to determine whether or not they will be allowed back into the Center/property.

If a “third strike” or a single especially egregious offense is committed, the parties involved will be placed in a mandatory cooling off period of no fewer than 15 days. In those 15 days, the parties involved must work with the Milford Youth Commission Discipline Subcommittee on a timeline to return to the MYC, if they choose to do so. The Subcommittee, in conjunction with MYC staff and if necessary, members of the Milford Town Government and Milford Police Department, will meet with all parties to hear their appeal for establishing a return to the center, if appropriate. The Discipline Subcommittee will be the final decision makers for any further disciplinary actions and if under what conditions, the affected party may return.

I understand the MYC Code of Conduct and Strike System *

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Medical Information

Medical Release

Knowing that the physical condition of my child is satisfactory to participate at the Milford Youth Center and activities, I hereby give permission for my child to participate. I further accept responsibility for my child in case of injury. I hereby release the Milford Youth Center and its employees, the town and their agents, and such other officers and/or volunteers from any liability that may occur to my child as a result of an accident. As the parent/guardian, I hereby give my/our approval to his/her participation in any and all Milford Youth Center activities during the current summer camp program. I/We assume all risks and hazards incidental to such participation, including transportation to and from the activities; and I/We do hereby waive, release, absolve, indemnify and agree to hold harmless the Milford Youth Center, the town of Milford, the organizers, supervisors, sponsors, participants, and persons transporting my/our child to or from activities, for any claim arising out of an injury to my/our child to the extend covered by accident or liability insurance. On rare occasions, an emergency requiring hospitalization and/or surgery develops. As a general rule, anesthesia may not be administered to or operations performed upon a minor without written permission by his/her parent/guardian. Therefore, in order to prevent a dangerous delay, if an emergency does occur and we are unable to contact the parent or legal guardian, the parent/guardian is asked to sign the release form below. In the event of injury or illness to me/my child, I hereby authorize Milford Youth Center representative(s) to secure whatever treatment is deemed necessary and, if recommended by an attending physician, the administration of an anesthetic or surgery. We do hereby release and discharge the Milford Youth Center, officers, employees, and agents, from any and all actions or claims for damages suffered by me/us or my/our child, as a result of the permission for any medical care for my/our child during his/her participation in any Milford Youth Center activity, event or trip. *

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Does your child have any allergies? *

Yes

No

Does your 2nd child have any allergies? *

Yes

No

Does your 3rd child have any allergies? *

Yes

No

Does your 4th child have any allergies? *

Yes

No

What are your child's allergies? We will be asking for a Doctor's Note and any instructions *

What are your 2nd child's allergies? We will be asking for a Doctor's Note and any instructions *

What are your 3rd child's allergies? We will be asking for a Doctor's Note and any instructions *

What are your 4th child's allergies? We will be asking for a Doctor's Note and any instructions *

Does your child need medication during this program? *

Yes

No

Does your 2nd child need medication during this program? *

Yes

No

Does your 3rd child need medication during this program? *

Yes

No

Does your 4th child need medication during this program? *

Yes

No

What medication does child 1 need during this program (Dose and frequency)? *

What medication does child 2 need during this program (Dose and frequency)? *

What medication does child 3 need during this program (Dose and frequency)? *

What medication does child 4 need during this program (Dose and frequency)? *

Do we have your permission to give your child(ren) hand sanitizer during this program? *

Yes

No

Are there special medical concerns that event supervisors should know about, including epilepsy, asthma, diabetes, previous injuries to bones/joints, etc, and if so, please specify (if your child has a history of motion induced medical conditions or experiences motion sickness please specify):

Please list any chronic illnesses, mental health needs, or behavioral information

I understand the Milford Youth Center Health Care Policy. Health Care Policy linked here. *

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Medical Information

Do you have the same physician for all of your children? *

Yes

No

Physician: *

Physician Phone Number *

Physician Address *

Physician 2: *

Physician 2 Phone Number *

Physician 2 Address *

Date of Last Tetanus shot * +

Date of Last Tetanus shot for child 2 * +

Date of Last Tetanus shot for child 3 * +

Date of Last Tetanus shot for child 4 * +

Please provide a copy of your child(ren)'s most recent physical, with proof of vaccines and physicians signature (NOT JUST LIST OF CHILDS VACCINES).

Upload a copy of your child(ren)'s most recent physical(s) with proof of immunization here and Physicians signature (If not within the year, please still attach most recent copy of your child(ren)'s physical(s)). This is easily obtained through your child's pediatrician upon request. Please note that the MYC team will be in contact with any questions from our nurse consultant and/or if we need an updated physical. *

Milford Youth Center does not purchase insurance for youth participants. Please provide participant insurance information below.

Hospitalization Insurance Company *

Hospitalization Insurance Policy Number *

Company address *

Company Phone Number (full number with area code) *

I/we acknowledge that we have carefully read the above medical authorization and know the contents thereof *

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