JCC Day Camps Registration 2015 Grades 6-9 PreSchoolers Age 4-5 ...
JCC Day Camps Registration 2015 Please mail or drop off completed form to JCC Day Camps, 360 Amity Rd., Woodbridge, CT 06525 Camper’s Name__________________________________ M F Birthdate___________ Grade as of 9/15___ Address___________________________________________________________________________________ City_________________________________________________ State_____________ Zip___________________ Tel. (
)_______________________ Camper’s E-mail (if applicable)__________________________________
Camper lives with: Both Parents Mother Father Other ______________________________________ T-shirt: Child: Sm Md Lg
Adult: Sm Md Lg
Parent’s Name__________________________________ Workplace_____________________________________ Cell Phone (
)_______________________________ Email_________________________________________
Parent’s Name__________________________________ Workplace_____________________________________ Cell Phone (
)_______________________________ Email_________________________________________
Emergency Contact_______________________________________________ Tel. (
)____________________
Buddy Request (One name only/must be reciprocal and same grade)____________________________________________ The JCC attempts to accommodate requests but cannot guarantee placement of campers with friends. Placement is made at camp director’s discretion. Register by May 22 for the best chance to have bunk request fulfilled.
How did you hear about our camp? ________________________________________________________________
PreSchoolers
Age 4-5
Session 1 (June 22-July 17) (4 weeks - No camp July 3)
Half-day M-F 9a.m.-1p.m. $675m* / $875nm* Full-day M-F 9a.m.-4p.m. $1,095m / $1,295nm
Session 2 (July 20-August 7) (3 weeks)
Half-day M-F Full-day M-F
9a.m.-1p.m. $550m / $700nm 9a.m.-4p.m. $865m / $1015nm
Sessions 1 & 2 (7 weeks)
Half-day M-F Full-day M-F
9a.m.-1p.m. $1,225m / $1,575nm 9a.m.-4p.m. $1,960m / $2,310nm
Subtotal $___________________
Grades K-5 Choose any weeks below (your first 2 weeks must be consecutive - additional weeks do not need to be).
June 22-26 June 29-July 2 July 6-10 July 13-17 July 20-24 July 27-31 August 3-7
Grades 6-9 June 22-26 June 29-July 2 July 6-10 July 13-17 July 20-14 July 27-31 August 3-7
$580m* / _ $680nm* for 2 weeks $865m / _ $1,015nm for 3 weeks $1,095m /_ $1,295nm for 4 weeks $1,370m /_ $1,620nm for 5 weeks $1,595m / _ $1,895nm for 6 weeks $1,860m / _ $2,210nm for 7 weeks
Subtotal $___________________
Must register for a minimum of 4 full weeks. Choose any four.
4 weeks: $1,380m* / $1,580nm*
$____________
Additional weeks: $345m / $395nm per week $____________
* NOTE: m = JCC member / nm = non-member
Subtotal $___________________
Two more weeks of fun in the sun in a more relaxed and flexible program. Entering Grades K-9. 8/10 8/11 8/12 8/13 8/14 • $62m/$82nm per day $_________________ 5 full days • $300m/$400nm $______________________
Non-Profit Org. U.S. Postage PAID Bridgeport, CT Permit #648
S’more Camp August 10-21 8/17 8/18 8/19 8/20 8/21 • $62m/$82nm per day $_________________ 5 full days • $300m/$400nm $______________________
Subtotal $_____________________
No transportation offered.
Arrival/Dismissal
I Before/After Camp
Mon.-Fri., 7-9a.m. and/or 4-6p.m. Pay in advance (no refunds): $10 per a.m or p.m. Billed: $14 per a.m or p.m.
Monday Tuesday Wednesday Thursday Friday Monday Tuesday Wednesday Thursday Friday Monday Tuesday Wednesday Thursday Friday Monday Tuesday Wednesday Thursday Friday
Subtotal $_____________________
2. Exceptions to minimum week and/or consecutive policy may be considered - call Debra x253. 3. There will be no camp July 3.
Administration Fee $____________ ($200 after May 22rd.)
Before/After Camp Total $____________
Extra Shirt @ $12 each $____________
Sibling Discount – $_________ I would like to donate to the Send A Kid to Camp Scholarship Fund $18 $36 other $__________
4. $50 deposit per camper per week is non-refundable/non-transferable. Deposit must accompany this application. 5. Additional children from the same family receive a $25 discount for 4 weeks, $50 for 7 weeks. 6. If interested in our Counselor-in-Training Program, please call (203) 387-2522 x253 for an application. Check Enclosed
Camp Total $____________
TOTAL DUE $ ___________ Amount Enclosed $____________
Charge my: Visa Mastercard Discover Amex
Account Number:________________________________________ Exp. Date____________ Application Date_____________Signature_________________________________________ If paying by credit card, your card will be charged the balance for the regular camp season on May 22, 2015; S’more Camp on July 10, 2015. Payment plans are available. Terms of Agreement: I will comply with all transportation policies. I give my permission for photos of my child that are taken during the camp day to be used by the JCC for publicity and web advertising, social networking sites (Facebook, Flicker, YouTube) and/ or publications. I will comply with all camp policies and have read and agree to all fees & terms of enrollment included above. I give permission for my child’s address & telephone number to be distributed to camp bunkmates and for my child to participate in trips outside the camp premises of the JCC (there may be unscheduled, last minute trips.) I understand that there will be no fee reduction or reimbursment for absences or for children sent home due to disciplinary or adjustment problems.I hereby release and hold harmless the JCC, its officers, directors and employees from any claims, loss and liability relating to injury, illness or death to my child(ren) which may arise from participating in any JCC camp program.
Parent/Guardian:_____________________________ Date:__________Signature:_________________________________
For more information, call Debra Kirschner at 203.387.2522 x253
Become a JCC Member!
Enjoy the benefits of the JCC all year long! Get member rates on classes, vacation programs, and full use of the JCC facility including the pool, gym, playscape, racquetball courts, fitness center, and spinning. Please have a membership representative contact me.
360 Amity Road, Woodbridge, CT • 203.387.2522 • www.jccnh.org
1. A $200 administration fee will be charged for registration after May 22, with the exception of S’more Camp. Sign up now and SAVE!
Tuition Payment: Tuition, with the exception of S’more Camp, is due in full by May 22, 2015. Note: All new JCC membership forms and payment must be completed in order to qualify for member discount. Membership must be secured through the end of camp. Non-Member Fees: Non-member camp fees are available or join the JCC, enjoy the facility year round and get a reduced rate on camp by becoming a JCC member. Deposit: A non-refundable/non-transferable $50 deposit per child per week is due at the time of registration (e.g., $700 due for two children enrolled for 7 weeks). Bunk Request: Register by May 22 for the best chance to have bunk request met. Financial Assistance: A limited amount of financial aid monies is available. To be considered for financial assistance, call Nancy at 203.387.2522 x251. Medical Information: All campers must have completed medical forms on file in the camp office before starting camp. Please be sure to schedule physicals before the start of camp. We will accept physicals done within 3 years. A first aid provider is on duty during all camp programs. Transportation (June 22-August 7 only): Bus transportation for the Greater New Haven area is provided for full-day campers and the CIT program. The JCC cannot guarantee specific location requests. For a list of centralized bus stops, visit www.jccnh.org. For your child’s safety, compliance with the transportation policy outlined in the Camp Parents’ Manual is mandatory. Please Note: In the event that campers return from a field trip after the end of the camp day, parents will be responsible for transportation. Lunch: Campers must bring a bagged lunch that will be refrigerated. The JCC will provide a kosher dairy afternoon snack. Cancellation Policy: $50 per camper per week is non-refundable/non transferable. The remaining tuition balance will be refunded up until June 21, 2015. After June 21, only JCC program or membership credit will be given.
Important Notes
Consult the Camp Parents’ Manual for general and age-related policies.
360 Amity Road Woodbridge, CT 06525
attend After Camp be picked up at 4pm: take the Bus (No Charge):
JCC of Greater New Haven
Camp Policies:
My child will: attend Before Camp
)_______________________ Camper’s E-mail (if applicable)__________________________________
Camper lives with: Both Parents Mother Father Other ______________________________________ T-shirt: Child: Sm Md Lg
Adult: Sm Md Lg
Parent’s Name__________________________________ Workplace_____________________________________ Cell Phone (
)_______________________________ Email_________________________________________
Parent’s Name__________________________________ Workplace_____________________________________ Cell Phone (
)_______________________________ Email_________________________________________
Emergency Contact_______________________________________________ Tel. (
)____________________
Buddy Request (One name only/must be reciprocal and same grade)____________________________________________ The JCC attempts to accommodate requests but cannot guarantee placement of campers with friends. Placement is made at camp director’s discretion. Register by May 22 for the best chance to have bunk request fulfilled.
How did you hear about our camp? ________________________________________________________________
PreSchoolers
Age 4-5
Session 1 (June 22-July 17) (4 weeks - No camp July 3)
Half-day M-F 9a.m.-1p.m. $675m* / $875nm* Full-day M-F 9a.m.-4p.m. $1,095m / $1,295nm
Session 2 (July 20-August 7) (3 weeks)
Half-day M-F Full-day M-F
9a.m.-1p.m. $550m / $700nm 9a.m.-4p.m. $865m / $1015nm
Sessions 1 & 2 (7 weeks)
Half-day M-F Full-day M-F
9a.m.-1p.m. $1,225m / $1,575nm 9a.m.-4p.m. $1,960m / $2,310nm
Subtotal $___________________
Grades K-5 Choose any weeks below (your first 2 weeks must be consecutive - additional weeks do not need to be).
June 22-26 June 29-July 2 July 6-10 July 13-17 July 20-24 July 27-31 August 3-7
Grades 6-9 June 22-26 June 29-July 2 July 6-10 July 13-17 July 20-14 July 27-31 August 3-7
$580m* / _ $680nm* for 2 weeks $865m / _ $1,015nm for 3 weeks $1,095m /_ $1,295nm for 4 weeks $1,370m /_ $1,620nm for 5 weeks $1,595m / _ $1,895nm for 6 weeks $1,860m / _ $2,210nm for 7 weeks
Subtotal $___________________
Must register for a minimum of 4 full weeks. Choose any four.
4 weeks: $1,380m* / $1,580nm*
$____________
Additional weeks: $345m / $395nm per week $____________
* NOTE: m = JCC member / nm = non-member
Subtotal $___________________
Two more weeks of fun in the sun in a more relaxed and flexible program. Entering Grades K-9. 8/10 8/11 8/12 8/13 8/14 • $62m/$82nm per day $_________________ 5 full days • $300m/$400nm $______________________
Non-Profit Org. U.S. Postage PAID Bridgeport, CT Permit #648
S’more Camp August 10-21 8/17 8/18 8/19 8/20 8/21 • $62m/$82nm per day $_________________ 5 full days • $300m/$400nm $______________________
Subtotal $_____________________
No transportation offered.
Arrival/Dismissal
I Before/After Camp
Mon.-Fri., 7-9a.m. and/or 4-6p.m. Pay in advance (no refunds): $10 per a.m or p.m. Billed: $14 per a.m or p.m.
Monday Tuesday Wednesday Thursday Friday Monday Tuesday Wednesday Thursday Friday Monday Tuesday Wednesday Thursday Friday Monday Tuesday Wednesday Thursday Friday
Subtotal $_____________________
2. Exceptions to minimum week and/or consecutive policy may be considered - call Debra x253. 3. There will be no camp July 3.
Administration Fee $____________ ($200 after May 22rd.)
Before/After Camp Total $____________
Extra Shirt @ $12 each $____________
Sibling Discount – $_________ I would like to donate to the Send A Kid to Camp Scholarship Fund $18 $36 other $__________
4. $50 deposit per camper per week is non-refundable/non-transferable. Deposit must accompany this application. 5. Additional children from the same family receive a $25 discount for 4 weeks, $50 for 7 weeks. 6. If interested in our Counselor-in-Training Program, please call (203) 387-2522 x253 for an application. Check Enclosed
Camp Total $____________
TOTAL DUE $ ___________ Amount Enclosed $____________
Charge my: Visa Mastercard Discover Amex
Account Number:________________________________________ Exp. Date____________ Application Date_____________Signature_________________________________________ If paying by credit card, your card will be charged the balance for the regular camp season on May 22, 2015; S’more Camp on July 10, 2015. Payment plans are available. Terms of Agreement: I will comply with all transportation policies. I give my permission for photos of my child that are taken during the camp day to be used by the JCC for publicity and web advertising, social networking sites (Facebook, Flicker, YouTube) and/ or publications. I will comply with all camp policies and have read and agree to all fees & terms of enrollment included above. I give permission for my child’s address & telephone number to be distributed to camp bunkmates and for my child to participate in trips outside the camp premises of the JCC (there may be unscheduled, last minute trips.) I understand that there will be no fee reduction or reimbursment for absences or for children sent home due to disciplinary or adjustment problems.I hereby release and hold harmless the JCC, its officers, directors and employees from any claims, loss and liability relating to injury, illness or death to my child(ren) which may arise from participating in any JCC camp program.
Parent/Guardian:_____________________________ Date:__________Signature:_________________________________
For more information, call Debra Kirschner at 203.387.2522 x253
Become a JCC Member!
Enjoy the benefits of the JCC all year long! Get member rates on classes, vacation programs, and full use of the JCC facility including the pool, gym, playscape, racquetball courts, fitness center, and spinning. Please have a membership representative contact me.
360 Amity Road, Woodbridge, CT • 203.387.2522 • www.jccnh.org
1. A $200 administration fee will be charged for registration after May 22, with the exception of S’more Camp. Sign up now and SAVE!
Tuition Payment: Tuition, with the exception of S’more Camp, is due in full by May 22, 2015. Note: All new JCC membership forms and payment must be completed in order to qualify for member discount. Membership must be secured through the end of camp. Non-Member Fees: Non-member camp fees are available or join the JCC, enjoy the facility year round and get a reduced rate on camp by becoming a JCC member. Deposit: A non-refundable/non-transferable $50 deposit per child per week is due at the time of registration (e.g., $700 due for two children enrolled for 7 weeks). Bunk Request: Register by May 22 for the best chance to have bunk request met. Financial Assistance: A limited amount of financial aid monies is available. To be considered for financial assistance, call Nancy at 203.387.2522 x251. Medical Information: All campers must have completed medical forms on file in the camp office before starting camp. Please be sure to schedule physicals before the start of camp. We will accept physicals done within 3 years. A first aid provider is on duty during all camp programs. Transportation (June 22-August 7 only): Bus transportation for the Greater New Haven area is provided for full-day campers and the CIT program. The JCC cannot guarantee specific location requests. For a list of centralized bus stops, visit www.jccnh.org. For your child’s safety, compliance with the transportation policy outlined in the Camp Parents’ Manual is mandatory. Please Note: In the event that campers return from a field trip after the end of the camp day, parents will be responsible for transportation. Lunch: Campers must bring a bagged lunch that will be refrigerated. The JCC will provide a kosher dairy afternoon snack. Cancellation Policy: $50 per camper per week is non-refundable/non transferable. The remaining tuition balance will be refunded up until June 21, 2015. After June 21, only JCC program or membership credit will be given.
Important Notes
Consult the Camp Parents’ Manual for general and age-related policies.
360 Amity Road Woodbridge, CT 06525
attend After Camp be picked up at 4pm: take the Bus (No Charge):
JCC of Greater New Haven
Camp Policies:
My child will: attend Before Camp
