Camp Registration

Jewish Camp Week is back for TWO weeks this summer! Running from Mondays-Fridays July 27th to August 7th from 10:00 am to 3:30 pm each day. Camp Weeks are packed with art, trips, science, and learning, all in a fun and hands-on Jewish environment.

Mini Campers: Ages 3-4
Junior Campers: Ages 5-8
Senior Campers: Ages 9-13

This year, we will have before care available from 9:00-10:00 and after care available from 3:30-4:30 pm. It will be supervised play time where the kids will play and interact in an unstructured environment.

Secure your spot by registering today!
We never turn kids away for lack of finances. If you need a scholarship, please reach out!
I'd like to register my child for:*

Week 1: July 27 - July 31 ($330)Week 2: August 3 - 7 ($330)
Before Care

Week 1 before-care from 9:00-10:00 am ($75)Week 2 before-care from 9:00- 10:00 am ($75)
After Care

Week 1 after-care from 3:30-4:30 pm ($75)Week 2 after-care from 3:30-4:30 pm ($75)
Number of Children Registering
1. Child/ren’s Information
Child's Name*
First Name Last Name
Birth Date*

Month Day Year
Gender*

MaleFemale
Additional Registration

I'd like to register another child
I'd like to register my child for:*

Week 1: July 27 - July 31 ($330)Week 2: August 3 - 7 ($330)
Before Care

Week 1 before-care from 9:00-10:00 am ($75)Week 2 before-care from 9:00- 10:00 am ($75)
After Care

Week 1 after-care from 3:30-4:30 pm ($75)Week 2 after-care from 3:30-4:30 pm ($75)
Child's Name*
First Name Last Name
Birth Date*

Month Day Year
Gender*

MaleFemale
Additional Registration

I'd like to register another child
I'd like to register my child for:*

Week 1: July 27 - July 31 ($330)Week 2: August 3 - 7 ($330)
Before Care

Week 1 before-care from 9:00-10:00 am ($75)Week 2 before-care from 9:00- 10:00 am ($75)
After Care

Week 1 after-care from 3:30-4:30 pm ($75)Week 2 after-care from 3:30-4:30 pm ($75)
Child's Name*
First Name Last Name
Birth Date*

Month Day Year
Gender*

MaleFemale
2. Parents information
Phone Number*

Area Code Phone Number

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Mother's Name*
First Name Last Name
Work Phone*

Area Code Phone Number
Cell Phone*

Area Code Phone Number
E-mail* Primary email
Mother is:*

Jewish by BirthCoverted to JudaismNot Jewish
Maternal Grandmoter is:*

Jewish by BirthCoverted to JudaismNot Jewish
Father's Name*
First Name Last Name
Work Phone*

Area Code Phone Number
Cell Phone*

Area Code Phone Number
E-mail Primary email
Father is:*

Jewish by BirthCoverted to JudaismNot Jewish
Paternal Grandmother is:*

Jewish by BirthCoverted to JudaismNot Jewish
3. Emergency Information
Emergency Contact*
First Name Last Name
Phone Number*

Area Code Phone Number
Relationship*
Pediatrician
First Name Last Name
Phone Number

Area Code Phone Number
Insurance
4. Payment Information
Total

$0.00
I would like to request consideration for a scholarship

YesNo
Payment Plans*

I'd like to pay in full in JuneI'd like to split camp tuition into 4 payments from May-August

Payment*

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Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

Agreement*

I am signing up my child for camp. I give my child permission to attend all trips and receive medical care in the case of emergency, G-d forbid. I give RCJL - Chabad permission to photograph and videotape my children and use the photos and videos (without their names) for promotions and social media.
Does your child have any allergies?*

YesNo
If "yes", please list any allergies
In the car, my child uses:*

A 5 point harnessA booster seatNothing
Comments
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1. Child/ren’s Information

2. Parents information

3. Emergency Information

4. Payment Information