South Shore YMCA, Camp Burgess & Hayward Financial Assistance Application Please note that we only accept and review complete applications, containing: Completed Financial Assistance Application; Copy of your most recent Federal Income Tax Form; Verification of income (paystub) or unemployment; $50 deposit per participant, per program/session: Please attach a check or provide credit card details below. Credit Card Type: Card Number: / / / Expiration Date: / Security Code: Name as appears on card: Authorized Signature: The deposit will not be processed until you have been awarded and accepted a scholarship. Financial Assistance FAQ s: When and how can I submit my application? Applications are accepted as soon as we open registration, up until two weeks prior to the start of the program/session for which you are applying. Please send the completed application with accompanying documentation together in one envelope - we can not accept pieces of the application separately. Mail completed applications to: Camp Burgess & Hayward 75 Stowe Road, Sandwich, MA 02563 Attn: Meghan Hill How long will it take to review my application? Applications are reviewed in the order in which they are received; you will receive a reply via email within 7-10 business days of receipt of your application regarding your eligibility for assistance. How many sessions can I apply for? Financial assistance is applicable to two (2) weeks of summer programming and one (1) non-summer program per participant, per year. When does my balance have to be paid in full? All participant balances must be paid in full no later than two weeks prior to the start of the program. Failure to remit payment on time will result in automatic cancellation. Please contact Meghan Hill at mhill@ssymca.org or 508-428-2571, ext. 101 with any additional questions. Page 1 of 4
South Shore YMCA, Camp Burgess & Hayward Financial Assistance Application Parent/Guardian Address: City: State: Zip: Phone: Email Address: IMPORTANT Please attach the following to your application: Copy of your most recent federal income tax form. Recent pay stub or verification of income, or proof of unemployment. $50 deposit (per camper, per session) Please list all people living in your household. Name Current Age Name of Employer/School Have you ever applied for financial assistance before from Camp Burgess & Hayward? Yes No If yes, how much have you received previously per child? 2017: $ 2016: $ Financial Information Please itemize your monthly, pre-tax income and expenses: Gross wages/salary (household) Child Support Social security Food Stamps Retirement Income (Non-social security) Other Income (please explain) Total Monthly Income Monthly Household Income Rent/Mortgage Food Medical Utilities Car Tuition Other (please explain) Total Monthly Expenses Monthly Household Expenses How much can you afford to pay towards our programming for each child? $ Page 2 of 4
South Shore YMCA, Camp Burgess & Hayward Financial Assistance Application Please explain why you are applying for Financial Assistance. If your child/ren is a returning participant, please tell us how our programs have been beneficial and impactful to you and your child/ren. We are working to gather stories of impact that relay the good work that we do! Would you be willing to share your family's Camp Burgess & Hayward story with us to help us garner support for our Campership Fund? Yes, I would like to share our story - feel free to quote what I ve written here. Yes, I would like to share our story - but, please keep it anonymous. No, I do not want to share our story. To the best of my knowledge, the information submitted in this application is correct. Date: Signature: Page 3 of 4
FINANCIAL ASSISTANCE PARTICIPANT INFORMATION You may use this form for up to four participants/siblings living in the same household Participant #1 Participant #2 Participant #3 Participant #4 Summer Programs Cancellation Policy: Cancel before May 1, 2018 100% program fees paid are refundable, less non-refundable deposit* Cancel on or after May 1, 2018 50% program fees paid are refundable. less non-refundable deposit* Cancel within 14 days of program start date No refund, except in the case of medical necessity (documentation must be provided).* *Deposits are not refundable or transferrable under any circumstances. Non-Summer Programs Cancellation Policy: Cancel within 14 days of program start date No refund, except in the case of medical necessity (documentation must be Provided by a medical professional).* *Deposits are not refundable or transferrable under any circumstances. Page 4 of 4
Summer 2018 Dates & Rates (June 24 - August 24) Camp Burgess for Boys & Camp Hayward for Girls Overnight Camp for Ages 7-16 Session Dates Fee Session 1 June 24 - July 6 $1,690 Session 1a June 24 - June 29 $845 Session 1b July 1- July 6 $845 Session 2 July 8 - July 20 $1,690 Session 3 July 22 - August 3 $1,690 Session 4 August 5 - August 17 $1,690 Session 5 (Co-ed Week) August 19 - August 24 $845 Horseback Riding Lessons Available sessions 1, 1a,1b, 2, 3, 4 & 5 Five 2-hour lessons $330 Camp is open year round. We have a busy schedule of programs for all ages. We are also open for bookings, providing the perfect place for outdoor education, teambuilding, retreats, and special events, including weddings. Program 2017-2018 Dates Price and Information Camp Open Houses October 1, April 29, May 20 Tours start at Camp Burgess, 1-4 pm Fall Service Weekend October 28-29, 2017 $50 - Call camp to register 5K Scenic Trail Run & Fall Festival October 29, 2017 Ski & Snowboard Adventure February 18-23, 2018 $825 April Vacation Camp April 15-20, 2018 $525 South Shore YMCA - Camp Burgess & Hayward 75 Stowe Road, Sandwich, MA 02563 Phone: 508-428-2571 Website: www.ssymca.org $20 - Benefits the Campership Fund! Volunteer Day May 12, 2018 We pay you with food and good karma! Spring Service Weekend May 11-12, 2018 $50 - A weekend of volunteering and fun Family Camp Memorial Day Please inquire for pricing Burgess & Hayward Road Crew Various Weekend Dates Free and fun community service projects Alumni Reunion Labor Day Weekend In celebration of the 90th Anniversary of Burgess! More information TBA
Summer 2018 Dates & Rates Cape Cod Adventure Camp 1 June 24 29 $825 Big Chill 1 June 24 29 $775 Base Camp Service Week 1 June 24 29 $495 Mini Adventure Weekend 1b June 29 July 1 $100 Cape Surf + Stuff 1 July 1 6 $850 Martha s Vineyard Bike 1 July 1 6 $815 Castaways 1 July 1 6 $610 Mini Adventure Weekend 2a July 6-8 $100 Cape Cod Adventure Camp 2 July 8 13 $825 Nantucket Biking 2 July 8 13 $815 Underwater Adventures 2 July 8 13 $800 Mini Adventure Weekend 2b July 13 15 $100 Cape Surf + Stuff 2 July 15 20 $850 Big Chill 2 July 15 20 $775 Castaways 2 July 15 20 $610 Mini Adventure Weekend 3a July 20 22 $100 White Mountain Sampler July 22 August 3 $1725 Cape Cod Adventure Camp 3 July 22 27 $825 Martha s Vineyard Bike 3 July 22 27 $815 Cape Surf & Stuff Level 2 July 22 27 $850 Mini Adventure Weekend 3b July 27 29 $100 Cape Surf + Stuff 3 July 29 - August 3 $850 Big Chill 3 July 29 - August 3 $775 Castaways 3 July 29 - August 3 $610 Mini Adventure Weekend 4a August 3-5 $100 Cape Cod Adventure Camp 4A August 5 10 $825 Nantucket Biking 4 August 5 10 $815 Underwater Adventures 4 August 5 10 $800 Mini Adventure Weekend 4b August 10 12 $100 Cape Surf + Stuff 4 August 12 17 $850 Cape Cod Adventure Camp 4B August 12 17 $825 Castaways 4 August 12 17 $610