2024 BCYC Summer Camp Registration
  • The BCYC is offering 9 weeks of full day programs 
  • Monday - Friday, 8am-5:00pm | $130 weekly | $1 charge for every minute late for pickup
  • Friday is "drop in day" that is the only day you will be allowed to drop in for $30 per day. 
  • After camp care from Bandon School District's summer camp $10 per day
  • Breakfast & Lunch will be provided by Bandon School District Monday - Thursday, allergy accommodations will be met.
  • You will need to bring breakfast and lunch on Fridays only. 
  • Swimming will be Mon, Tues, Wed, and Friday | Field trips will be on Thursdays
  • Below you will have 3 different options, our weekly summer camp, Friday drop in days or after camp care from Bandon School District's summer camp. 
  • We ask that you please pick and plan in advance, this helps us staff accordingly. 
  • Reminder, we are only closed July 4th and 5th all summer 
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Parent/Guardian Name

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Parent/Guardian Phone Number *
Parent/Guardian Email *
Parent/Guardian Occupation *
Home Address *
Best form of communication *
Participant Name 1 *
Participant Date of Birth *
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Ethnicity *
Participant Name 2
Participant Date of Birth
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Participant Name 3
Participant Date of Birth
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Ethnicity
Participant Name 4
Participant Date of Birth
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Ethnicity
Emergency Contact  (Name, Relationship to Participant, Contact Number)                                                   *
Emergency Contact  (Name, Relationship to Participant, Contact Number)                                                   *
Please list any medications (over the counter or prescibed) include medication (name, dosage) when taken (specific times, purpose.                                                 *
Name of insurance and policy number *
Participant is allowed to receive *
Required
Please list all known allergies including food, drug, latex, and insect stings: *
Week Registering *
Required
Drop in Fridays, $30 per Friday. These are the ONLY "drop in" dates available. 
After care at BCYC from Bandon School District Summer Camp from 3:15PM- 5:00PM. You have the option to attend Bandon School District's summer camps (if you are currently or previously enrolled in Bandon School District) $10 Per Day. 
Photo Release:  I understand that photographs of participants are taken during BCYC activities. Images including my child/the participant may be published by the Bandon Community Youth Center on Facebook, Website or printed materials. *
Authorization for Consent to Medical Treatment          Any individual under the age of 18 years without a completed Consent to Medical Treatment form on file prior to the start of camp will not be able to participate in any camp activity. The directors and staff are not responsible for any medical, dental or other expenses resulting from accidents.I hereby authorize the Bandon Community Youth Center Summer Camp staff to consent to any diagnostic procedure (including x‐rays), to the administration of any medical or surgical treatment, or to any hospital care when any, or all are rendered under the general supervision of any physician and/or surgeon licensed under the provisions of Oregon Revised Statute 677, the Medical Practice Act.  My child/the participant is in good health and I know of no medical reason why he/she cannot participate in any camp activities.  This authorization is given in advance of any specific diagnosis, treatment or medical care being required. By typing your name you are agreeing to the above. *
I am the parent or legal guardian of the Participant. I understand the legal consequences of signing this document, including (a) releasing Bandon Community Youth Center from all liability on my and the Participant’s behalf, (b) promising not to sue on my and the Participant’s behalf, (c) and assuming all risks of the Participant’s participation in this Activity, including travel to, from and during the Activity.  Please type your name below to agree. *
I allow Participant, to participate in this Activity. I am aware of the risks associated with traveling to/from and participating in this Activity, which include but are not limited to physical or psychological injury, pain, suffering, illness, disfigurement, temporary or permanent disability (including paralysis), economic or emotional loss, and/or death.  I understand that I am responsible for the obligations and acts of Participant as described in this document. I agree to be bound by the terms of this document.  I have read this document, and I am signing it freely. No other representations concerning the legal effect of this document have been made by me. Please type your name to agree. *
I hereby authorize the Bandon Community Youth Center (BCYC) to share information with the Bandon School District regarding my child. This authorization is granted for the purpose of facilitating communication and coordination between the two entities regarding my child's participation in programs provided by both organizations. *
I the parent or guardian of the participant understand that additional signed forms are required as well as payment to complete registration. Please type your name to agree. *
Interested in a scholarship? *There are a limited amount* *
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