Harrisburg Area YMCA West Shore Branch
Class Registration Form
Northern York County Programs
West Shore YMCA Front Desk 502-1177 975-1897
410 Fallowfield Road Attn: Front Desk
Camp Hill, PA 17011
Class fees must be paid at the time of registration, whether by mail, fax, phone or in person. Fax or Phone Registration require a credit card. Registration can now be done on-line.
REGISTRATION INFORMATION (Please print)
Name ____________________________________________ Birthdate ___/___/___
(If parent, please provide us with your birthdate.)
Address_____________________________________________________________________
(street, city, state, zip)
Home Phone ________________ Work Phone_______________ E-Mail ____________________________
|
Participant’s Name |
Age |
Birthdate |
Class |
Day/time |
Session |
Fee |
Total Due: _______
o Check o Visa o MasterCard o Discover
Card Number ________________________________ Exp. Date __________
Cardholder’s Signature _______________________________
Financial assistance is available. An application can be obtained at any of our branches.
The YMCA reserves the right to cancel classes with insufficient registration.
The Front Desk will not accept registration forms prior to registration time.
Class fees must be paid at the time of registration, whether by mail, fax, phone or in person. Fax or Phone Registration require a credit card.
Credit, not cash, will be given for cancellations made after the session has started.
Cash refunds will be given for medical reasons only.