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Camp Registration

Camp Registration

Camper Registration Form Summer 2017

**Register before March 1st 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: June 26 - 30 Week 4: July 17 - 21 Week 1: June 26 - 30 Week 4: July 17 - 21
Week 2July 3 - 7 Week 5: July 24 - 28 Week 2: July 3 - 7 Week 5: July 24 - 28
Week 3: July 10 - 14 Week 6: July 31 - August 4 Week 3: July 10 - 14 Week 6: July 31- August 4
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 - June 26, 2017.

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

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Camp Updates
Register by March 31st and save 10%!
Location:
437 Manhattan Avenue
Corner 118th St.
Contact:
646-820-2487