JCC Day Camps Registration 2016 PreSchoolers Age 4 Grades K-5

JCC Day Camps Registration 2016 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 9/16__________ __

Address_________________________________________________________________________________________________________________ City_________________________________________________ State_____________ Zip___________________ Tel. ( _______) ______________________ Camper lives with: T-shirt: Child:  Sm

Camper’s E-mail (if applicable) _________________________________________ __

Both Parents  Md

Mother

 Lg

Adult: Sm

Father

Other ______________________________________

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 27 for the best chance to have bunk request fulfilled.

How did you hear about our camp? _______________________________________________________________________________________________

PreSchoolers Age 4 Session 1 (June 27-July 22) Half-day

M-F

9a.m.-1p.m.

(4 weeks - No camp July 4) Full-day

M-F

9a.m.-4p.m.

Session 2 (July 25-August 12) Half-day

M-F

9a.m.-1p.m.

(3 weeks) Full-day

M-F

9a.m.-4p.m.

Sessions 1 & 2 Half-day

M-F

9a.m.-1p.m.

(7 weeks) Full-day

M-F

9a.m.-4p.m.







 $710m* / $860nm*  $1,130m / $1,330nm  $565m / $765nm  $895m / $1,045nm  $1,199m / $1,549nm  $1,915m / $2,265nm



Subtotal $___________________

Grades K-5 Choose any weeks below (your first 2 weeks must be consecutive - additional weeks do not need to be).



 June 27-July 1  July 5-8  July 11-15  July 18-22  July 25-29  August 1-5  August 8-12

Grades 6-9



$600m* / _ $700nm* for 2 weeks $895m / _ $1,045nm for 3 weeks $1,130m /_ $1,330nm for 4 weeks $1,410m /_ $1,660nm for 5 weeks $1,645m / _ $1,945nm for 6 weeks $1,915m / _ $2,265nm for 7 weeks



Subtotal $___________________

Must register for a minimum of 4 full weeks. Choose any four.

 June 27-July 1  July 5-8  July 11-15  July 18-22  July 25-29  August 1-5  August 8-12 * NOTE: m = JCC member / nm = non-member

 4 weeks: $1,420m* / $1,620nm*

$____________

 Additional weeks: $355m / $405nm per week $____________



Subtotal $___________________

Continued over u

S’more Camp August 15-26 Two more weeks of fun in the sun in a more relaxed and flexible program. Entering Grades K-9.

 8/15  8/16  8/17  8/18  8/19 • $64m/$84nm per day_ $____________  5 full days • $305m/$405nm $____________  8/22  8/23  8/24  8/25  8/26 • $64m/$84nm per day $____________  5 full days • $305m/$405nm $____________ 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): $12 per a.m or p.m. Billed: $16 per a.m or p.m.



My child will: attend Before Camp  Monday attend After Camp  Monday be picked up at 4pm:  Monday take the Bus (No Charge):  Monday



Bridgeport/Fairfield families call for details.



 Tuesday  Tuesday  Tuesday  Tuesday



 Thursday  Thursday  Thursday  Thursday

1. A $200 administration fee will be charged for registration after May 27, with the exception of S’more Camp. Sign up now and SAVE! 2. Exceptions to minimum week and/or consecutive policy may be considered - call Debra x253. 3. There will be no camp July 4. 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.



 Friday  Friday  Friday  Friday

Subtotal $_____________________



Important Notes

 Check Enclosed

 Wednesday  Wednesday  Wednesday  Wednesday



Camp Total $____________



Administration Fee $____________



Before/After Camp Total $____________



Extra Shirt @ $12 each $____________

($200 after May 27rd.)



Sibling Discount ­– $_________  I would like to donate to the Send A Kid to Camp Scholarship Fund other $__________  $18  $36

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 27, 2016; S’more Camp on July 11, 2016 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 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 employess 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.