Camper Application

Apply now for an experience of a lifetime!

(All fields are required)

Please consider my child for admission for the Jewish Camp of the Arts
Dates and Rates:

Camp Per Week $210

Summer Camp Grant:
New Campers $119 per week
Existing Campers $159 Per Week

Ages: 1-12 years
Times: 9am - 3:30pm
Lunch & Snack $30 Per Week

Pre Camp:

Week of June 9,
Week of June 16,

Camp:
June 23,
June 30,
July 7,
July 14,
July 21,
July 28

Post Camp
August 4,
Aug 11,

 

Before care 7:45am - 8:30am
After care 3:30pm - 5:30pm
Cost is $10 per hour for one child and $15 per hour for two children,
Before care & after care together is $90 per week
I Would like to pick the dates at a later date.

  Check the applicable option
My family will qualify for a scholarship with form 220


Pre Camp:
Week of June 9,
Week of June 16,
Camp:
Week of June 23,
Week of June 30, (Closed July 4,)
Week of July 7,
Week of July 14,(July 15, No After Care)
Week of July 21,
Week of July 28,
Post camp:
Week Aug 4,
Week Aug 11,
Before Care
Monday  Tuesday  Wednesday  Thursday  Friday
After Care
Monday  Tuesday Wednesday  Thursday  Friday

Sponsor a child
You can make a difference in the life of a child by donating to our scholarship fund. As JCA grows, so does the need for scholarships. JCA and Jewish Kids Programs strives to provide a quality Summer Camp to all children regardless of their financial ability. This means that as a Jewish camp, we look to you, our community, to help fund our scholarship program.
Contribute $18 to the Camp Scholarship Fund
Contribute $25 to the Camp Scholarship Fund
Contribute $50 to the Camp Scholarship Fund
Contribute $100 to the Camp Scholarship Fund
Contribute $250 to the Camp Scholarship Fund
would like to sponsor towards the scholarship program
I would like my child to take swimming lessons at $15 per session - minimum 2 sessions
Parents are responsible to provide 2 water bottle everyday



Quantity
Camper Shirt Size
Child Size:  X-Small Small Medium Large
Adult Size: Small Medium Large X-Large
Child's Name:
(Last)                             (First)                                (Middle)
Address 1:
Address 2:    
(City)                                         (Zip Code)
Contact info:         
      Phone Number                                       Email Address
Date of Birth:           
                                                     (Place of Birth)
School attending:            
       (School)                                 (Grade entering)
Family:            
(Brother/s age)

                  (Sister/s age)               
Father or Guardian:
      
(Father or Guardian Name)    
  
                      (Profession)                       
    
(Address)

  (Telephone #)

(Religion)
Mother or Guardian:
       
(Mother or Guardian Name)     

  (Profession)   
     
  (Address) 
   
   (Telephone Number)

(Religion)
Shul affiliated with:
(if applicable)
Persons Permitted to remove child:

(Full Name)

(Full Name)

(Full Name)
In case of illness, accident or emergency: If for some reason the parents or guardians cannot be reached, please provide
persons to be contacted in case of illness, accident or emergency. if none, indicate "NONE"
   
(Name)                                 (Address)                            (Phone #)


(Relationship)
Special Instructions or areas of concern:
Is your child allergic to anything?:
Emergency Medical Authorization: I give authorization for Emergency Medical Care in the event of a serious illness or accident and if parents cannot be reached.
              
                        (Date)                        (Signature of Parent or Guardian)
Payment

Payment Options:
Pay in full now Charge my Credit Card the $250 deposit today and the balance on February 31, 2012

Credit Card Type:
Account #:
Exp. Date: CVC code: (3 or 4 digit security code)
Name(as it appears on card):
Amount: (Total of all above registrations)
Agreement :   
1. Chabad House Lubavitch of Palm Beach DBA, "The Jewish Camp of the Arts", reserves the right to terminate the enrollment of any child in the event of the breach of this tuition agreement.

2.Payment must be received prior to camp.

3.No refunds, credits, pro-rations or make-up days are available for absences due to illness, holidays, family vacations, or for any other reason.

4.In the event that a child is dismissed from the program due to misbehavior, no refund will be made.

5.The child and parents agree to abide by the rules and regulations set forth by the camp.

6.Chabad House Lubavitch of Palm Beach DBA, "The Jewish Camp of the Arts", will make every effort to protect the health and safety of every child. However, it will not be responsible for the injury or health impairment of any camper.
 
7.I give my child permission to go on all outings with this camp.

8.I give permission for Chabad of Palm Beach DBA The Jewish Camp of the Arts its representatives, volunteers and employees to Photograph during the camp 2013 session.
I further give permission and consent to the Jewish Camp of the Arts to copyright, use and publish the same in print and/or electronically with or without my child’s name and for any lawful purpose, including such purposes as publicity, illustration, advertising, and web content. Photographs may be published and used to illustrate and promote the camp experience, and its camp programs.
We have carefully read and understand this tuition agreement and agree to be bound to all of its provisions.

Signed  Date
Security Image  Security Code
Enter above Security Code