Camper Registration Form Summer 2018

**Register before April 10 and save 10%!**

Camper Information
Camper 1 Full Name: Camper 2 Full Name:
Hebrew Name: Hebrew Name:
Nick Name: Nick Name:
Date of Birth: Date of Birth:
Male Female Male Female
Current School: Current School:

Grade Entering: Grade Entering:

T-shirt Size

(Every Camper will receive a complimentary t-shirt.)

T-shirt Size

(Every Camper will receive a complimentary t-shirt.)

Weeks Attending: Weeks Attending:

Week 1: Aug 6-10

Week 2 Aug 13-17 

Week 3: Aug 20-24

Week 4: Aug 27-31 

Week 1: Aug 6-10

Week 2: Aug 13-17

Week 3: Aug 20 - 24

Week 4: Aug 27-31 

   
Additional Information
Is your child potty trained? Is your child potty trained?
Yes No Recently trained, please remind often. Yes No Recently trained, please remind often.
Does you child nap? If yes, for about how long? Does you child nap? If yes, for about how long?
Does your child have any allergies or dietary concerns? If yes, please explain: Does your child have any allergies or dietary concerns? If yes, please explain:
Does your child have any medical or behavioral concerns we need to know about? If yes, please explain: Does your child have any medical or behavioral concerns we need to know about? If yes, please explain:
Family Information
Parent 1: Cell Phone: Email:
Hebrew Name: Work Phone:  
 
Parent 2: Cell Phone: Email:
Hebrew Name: Work Phone:  
 
Is the natural mother of the child/ren Jewish? Yes No
Are there any conversions or adoptions in the family? If yes, please explain:

How did you hear about us?


Payment Information:

A $100.00 non-refundable deposit per child must accompany this registration form. Once you submit your registration, you will receive an acceptance by email, including your balance of tuition which must be paid prior to the first day of camp - August 6, 2018.

Total amount to charge to card:
Method of Payment: Credit Card Number:
Expiration Date: Zip Code:
 

Please contact us with any questions!

mushka@jewishharlem.com

646-632-5474