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Register Online Summer 2017

Register Online Summer 2017

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Summer Camp 2017 Registration Form

Please fill out the form below carefully. When you press submit, this form will be sent to our administrative office.

There is a $100 non-refundable deposit required with each child's registration form. We must receive both the completed registration form and the deposit before we can begin the registration process for your child.


Click here for Camp Information & Tuition Rates

Click here for Cancellation policy

Note: Please use a separate form for each child.

Camper Information
Name of Camper
  Last
First
Hebrew

gender
Male
Female

         
Address
  Street

City

State
Zip
Date of Birth
  Month
Date
Year
 

School &
Grade
Entering

 

school entering Fall '17

grade entering Fall '17

 
Synagogue affiliation      
Parents' Names
  Father

Mother

 
Phone Numbers & Email   Father's cell phone

Mother's cell phone

 

Father's email

Mother's email

           
Please indicate which week(s) your child will be attending:

Week 1; June 26 - 30

Week 2; July 3 - 7

Week 3; July 10 - 14
 
Week 4; July 17 - 21

 
Transportation & Extended Care:
If you will be needing transportation and/or extended care, please check the appropriate box(es).
Note that there are extra charges for these services.
 

EXTENDED CARE: AM PM
We will contact you with further information.

TRANSPORTATION: AM Pick-up PM Drop-off
Transportation subject to availability.

   

Comments

IMPORTANT
 
 

A $100 non-refundable deposit is due with this registration. I will be paying this by:
check credit card (Visa, Mastercard, AmEx, or Discover)

Coupon code:
I agree to the terms stated on this registration form and in in the Parent Handbook. I give my child permission to attend all trips, and receive medical care in the case of emergency. By signing below, you agree to this policy.
  Parent Signature:
  Date of Registration:
 Email