BUILD
LEARN
PLAY
Bricks 4 Kidz: Minecraft 1/2 Day Camp
Minecraft is a game about placing blocks to build anything you can imagine. At night
monsters come out, make sure to build a shelter before that happens. Experience the
world of Minecraft with LEGO bricks. Campers will face new challenges each day,
building motorized Bricks 4 Kidz models and crafting key elements from the popular
Minecraft game. All campers take home a custom mini-figure at the end of the week!
Models built: Jackhammer, Fish, Dinosaur, Minecart and Sailboat! This camp is not
affiliated with Minecraft.com.
WHO:
Kids 7-12 years old
WHEN:
TIME:
July 18-July 22
9:00 AM-12:00 PM
COST:
$70 Members/ $90 Program Participants
LOCATION: LEO UNITED METHODIST CHURCH
13527 Leo Road
Leo, IN 46765
REGISTRATION ENDS JULY 8
Questions? Contact Sarah Ruiz at (260) 449-4633 or [email protected]
To register online or download a registration form go to www.fwymca.org/childcare_services.php
½ DAY SUMMER CAMPS
Choose the camp(s) attending:
Chefs in Training
Junior Chefs
Adventures in Art
Mini Picassos
Cheer Camp (Ages: 5-8)
Cheer Camp (Ages 9-13)
Bricks 4 Kidz
Child’s Full Name: _________________________________________________________________________________________________________________________________________________________
Address: _____________________________________________________________________________ City: __________________________________ State: _________ Zip: ___________________
Birth date: ___________/____________/___________
Gender:
Male
Female
Parent/Guardian Name (s): _______________________________________________________________________________________________________________________________________________
Address: _____________________________________________________________________________ City: _________________________________ State: _________ Zip: _____________________
Place of employment: _____________________________________________________________________________ Work number: (_________)__________________________________________
Home Phone Number: (__________)__________________________________________
Alt. Phone Number: (__________)_______________________________________________
E-mail address: _____________________________________________________________________________________________________________________________________________________________
Allergies/Health Care Needs: ___________________________________________________________________________________________________________________________________________
Family Physician/Phone: ______________________________________________________________________________ Preferred Hospital: ________________________________________
AUTHORIZED PICK UP/ EMERGENCY CONTACTS (Must be 18 years or older)
I hereby give my consent for the following individuals to pick up my child from our summer ½ Day Camp Program. I
understand the YMCA of Greater Fort Wayne is not responsible for my child once they have been signed out of the program.
In an emergency situation, the YMCA will always try to contact the parent(s)/guardian(s) first. In case the
parent(s)/guardian(s) cannot be reached, we will contact the following emergency contacts. Please list at least two
emergency contacts in order of preference for contact.
Name: _______________________________________________________________________ Name______________________________________________________________________
Relation to child: _________________________________________________________ Relation to child: _______________________________________________________
Home #: ____________________________________________________________________
Home #: __________________________________________________________________
Cell #:
Cell #:
____________________________________________________________________
Work #: ___________________________________________________________________
Authorized Pick Up
Emergency Contact
__________________________________________________________________
Work #: _________________________________________________________________
Authorized Pick Up
Emergency Contact
PARENT/ GUARDIAN(S) CONSENT
My child has permission to participate in YMCA ½ Day Camp activities. Basic first aid and emergency treatment are
authorized, I recognize and acknowledge that there are certain risks of physical injury, and agree to assume full risk of
injuries, damages or loss which my child may sustain as a result of participating in any and all activities connected with or
associated with such program. I authorize the YMCA to transport my child via emergency transportation should it be
deemed necessary by the YMCA staff.
I give the YMCA permission, without limitation or obligation, to use photography, video, or audio recordings of my child
participating in YMCA ½ Day Camp programs for the promotion or interpretation of the YMCA.
Parent/Guardian Signature
Questions? Contact Sarah Ruiz
Phone: (260) 449.4633
Email: [email protected]
Please make checks out to: YMCA
Date
Mail registration form with payment to
CHILD CARE SERVICES
ATTN: SARAH RUIZ
1117 South Clinton Street
Fort Wayne, IN 46802