Summer 2016 Registration Form
Camper's Last Name
Camper's Gender
Camper's Age as of June 1st
Parent's Last Name
May we text you?
Who's your carrier?
Does your child have allergies?
If yes, explain:
Camper's First Name
Camper's Nick Name
Camper's Birthdate
Parent's First Name
Parent Phone Number
Parent's Email
Camper T-shirt size:
2T
3T
4T
Morning of Fun 9am - 12pm
Sml 5/6
Med. 7/8
Please pick your time of day:
Morning of Fun (through Lunch) 9am - 1pm
Female
Male
All Day Fun 9am - 3:30pm
Please pick your days and weeks:
My camper will be attending every day for all 8 weeks:
My camper will attend every ________ for all 8 weeks:
Mon
Tues Wed Thur
Fri
My camper needs Pre-care.
7:30 - 8:50 ($7 per day)
My camper will be attending (Check all that apply):
Week 1 - June 6th - June 10th
Week 2 - TUES. June 14th - June 17th (4 days)
Week 3 - June 20th - June 24th
Week 4 - June 27th - July 1st
Week 5 - TUES. July 5th - July 8th (4 days)
Week 6 -July 11th - July 16th
Week 7 - July 18th - July 22nd
Week 8 - July 25th - July 29th
My camper will need post care. Please write in the time for each day of the week (4pm, 4:30pm, 5pm, 5:30pm, or 6pm)
Mon
Tues
Wed
Thur
Fri
Week 1 - June 6th - June 10th
Week 2 - TUES. June 14th - June 17th (4 days)
Week 3 - June 20th - June 24th
Week 4 - June 27th - July 1st
Week 5 - TUES. July 5th - July 8th (4 days)
Week 6 -July 11th - July 16th
Week 7 - July 18th - July 22nd
Week 8 - July 25th - July 29th
My camper will need a hot lunch on the following days
($6 a day)
Week 1 - June 6th - June 10th
Week 2 - TUES. June 14th - June 17th (4 days)
Week 3 - June 20th - June 24th
Week 4 - June 27th - July 1st
Week 5 - TUES. July 5th - July 8th (4 days)
Week 6 - July 11th - July 16th
Week 7 - July 18th - July 22nd
Week 8 - July 25th - July 29th
Mon
Tues
Pizza & Salad Taco Bar
Wed
Mac N Cheese
Thurs
Baked Potato &
Salad Bar
Fri
Pasta Bar
Summer 2016 Registration Form
Registration Policies
1. All applications are subject to availability within session and age group.
2. Camp fees will be billed each month in the same way as ECC school fees. Your invoice will
include any "A La Carte" charges from camp such as pre/post care and lunches.
3. You are agreeing to enroll your child in our Summer camp for the agreed upon number of
weeks.
4. I understand that ALL camp fees are due by July 6, 2016.
5. I hereby understand that I am being billed $150 as a deposit to hold my child's spot at camp.
The $150 will be applied to the cost of tuition. I will be notified within 48 hours with the cost
of my full summer tuition.
Parents, Please choose which statements apply to your child & that you agree with:
1. I understand that my child cannot be admitted to camp without an up-to-date physician's statement.
2. I authorize Camp B'nai Ami to use still, slide, or video photographs of my child for its public relations.
3. I give my 3-4 year old child permission to ride the bus to the Elk's Club Lodge for swimming with the
understanding that every effort will be made to ensure my child's safety.