Camp Chaverim 2022- Option B

For children born between January 2019 – November 2019

Schedule: 5 days/week (Monday-Friday), 8:50am - 11:50am
Regular Rate/Week: Members $750, Non-Members $790

A minimum enrollment of 3 consecutive weeks is required

CHILD INFORMATION:

* First Name

* Last Name

* Gender

* Birthday

* Mailing Address

* State

* Zip Code

New CamperReturning CamperSibling of Camper

Please list sibling(s) with date(s) of birth

Friend Requests: Please note that though every effort will be made to do so, we are not able to guarantee that all requests will be accommodated.

Friend Request #1

Friend Request #2

PARENT/GUARDIAN INFORMATION

* Adult 1 Name

* Email

* Phone number

Address (if different)

Adult 2 Name

Phone Number

Address (if different)

How did you hear about us:

Prior/Current FamilyWebsiteWord of mouthOther

Please tell us who we can thank for the referral:

If other, please indicate

REGISTRATION AND PAYMENT

Minimum: 3 consecutive weeks

Please note that the minimum enrollment requirement is to benefit each camper so that he/she feels comfortable in the space, and develops relationships with teachers and camp mates. The minimum requirement, listed per option, must be met before enrolling in additional single weeks.

I agree to pay a non-refundable deposit of $500 to Temple Israel Camp Chaverim (hereinafter referred to as “Camp”), upon filing this application. I agree to pay the balance due on or before April 29, 2022. If the Camp cannot accommodate registrant, all fees and deposits will be refunded. In the event this application is filed after April 29,2022 the entire amount is due with the application. All fees are non-refundable after April 29,2022. I acknowledge that the deadline to decrease the number of weeks for enrollment is April 29, 2022, and any changes after that date will not be refunded. I understand that no refund or adjustment will be made for absences, including but not limited to, illness or failure to provide a medical form. If the Camp finds it necessary to withdraw my child from Camp, I will be charged for the number of days and/or weeks attended. I agree to provide the Camp with a properly completed medical form, based on an exam performed less than one year prior to April 29,2022. as required by the City of New York, prior to my child attending Camp. I understand that each group has a minimum enrollment to run and should the minimum not be met, Camp will transfer my deposit to another group or refund it.

I hereby give my permission for my child to participate in all programs, activities and trips as part of the 2022 Camp Chaverim program. I hereby release Camp Chaverim, Temple Israel of the City of New York, or any of its sponsors, benefactors or employees from any liability arising out of any injury to my child. In the event of a medical or surgical emergency, I grant permission to Camp Chaverim to hospitalize secure proper treatment for and order injections, anesthesia or surgery for my child. Furthermore, I understand that payment for medical services is solely the family’s responsibility. I permit Camp Chaverim/Temple Israel of the City of New York to use my child’s photos or quotations for publicity purposes.

After-School Enrichment

Challah Registration

Pizza Registration