The JCC of Syracuse's Summer Camp offers programs for infants, preschoolers, school-age children and teens. Camp runs June 26 - August 18, 2017.
315-445-2360 | www.jccsyr.org 2017 School-Age JEWISH COMMUNITY CENTER - and CAMP Teen RISHON Camp Registration 2015 School-Age and Teen Camp Registration 5655 Thompson Rd., DeWitt, NY 13214 • Carefully One form read per the child. registration and • general Please camp print neatly. information. • Please Complete print both neatly. sides of this form. • Mailing Please and read billing registration will be and sent general to the camper’s information address. before completing this form. • No Mailing third-party and billing billing. will be sent to the Camper’s address. • Many camps have grade and equipment • requirements. Third-party billing Please will check not be program done. • descriptions *Many camps before have completing grade and registration. equipment requirements. Please check program descriptions prior to completing registration. JCC Membership Are you a JCC member? Yes No Use one form per child. JCC Membership # No refunds after May 19. Bus Transportation Request CAMPER INFORMATION Last Name First Name Age Address Sex (circle one) M F City State Zip Phone Birthdate T-Shirt Size (circle one) Youth: (6-8) (10-12) (14-16) Adult S M L School Grade Entering (2017-18) Child lives with Parent #1/Guardian Parent #2/Guardian PARENT #1 / GUARDIAN INFORMATION Last Name First Name Work Phone Home Phone Cell Phone Occupation PARENT #2 / GUARDIAN INFORMATION Last Name Email First Name Work Phone Home Phone Cell Phone Occupation Email EMERGENCY CONTACT INFORMATION (Other than Parent) MUST BE LOCAL Parents: Using the bus stop numbers from page 5 of the brochure, please indicate the stop most convenient for you for both the AM and the PM bus runs. AM ____________________________ PM ____________________________ How did you hear about us? (Please check the appropriate items) __ Friend/neighbor/ current member __ JCC membership mailings __ Attended camp previously __ Internet __ Post Standard __ Family Times __ Syracuse Parent __ Jewish Observer __ Camp Fair __ Other – Please Explain: EXTRA T-SHIRT ORDER FORM Please order my son/daughter extra camp T-shirts. Number of shirts___________________ Size: (circle one) Youth: (6-8 ) (10-12) (14-16) Adult: S M L Enclosed, please find $8.00 for each T-shirt ordered. Remember - Every camper will receive a free T-shirt at the start of his/her first session. Name # 1 Phone #1 Phone #2 Relationship Name # 2 Phone #1 Phone #2 Relationship PERMISSIONS My My son/daughter son/daughter has has my my permission permission to to go go on on field field trips trips during during the the time time camp camp is in is session. in session. I understand I understand that that I will I be will informed be informed of the of exact the exact date, time date, and time, destination and destination of each trip of each in advance trip in advance of departure. of departure. Field trips Field may be trips weather may be permitting. weather permitting. I give permission I give for permission my child to for go my child on trips to with go on persons trips with designated persons by designated the JCC Camp by the Director. JCC Camp Director. My son/daughter has my permission to participate in JCC overnights. Participation is not mandatory and signature does not guarantee My participation. son/daughter Overnights has my will permission take place to weeks participate 2, 4, 6, in and JCC 8 overnights. of camp. Children Participation must be is enrolled not mandatory in camp the and week signature of an does overnight not guarantee in order participation. Overnights will take place weeks 2, 4, 6, and 8 of camp. Children must be enrolled in camp the week of an overnight in to participate. Additional charges apply. order to participate. Additional charges apply. I give permission for photographs of my son/daughter to be used in any camp publicity or promotion. I give permission for photographs of my son/daughter to be used in any camp publicity or promotion. ______________________________________________ _______________________________________________ __________________ Camper’s __________________________________________ Name Parent/Guardian __________________________________________ Signature ___________ Date Child’s Name Parent/Guardian Signature 10 JCC of Syracuse | 2017 Summer Camp Guide Date
315-445-2360 | www.jccsyr.org 2017 After-Camp Clinics JEWISH COMMUNITY CENTER - CAMP RISHON Registration 2016 After-Camp Clinics & Teen Fitness Registration 5655 Thompson Rd., DeWitt, NY 13214 One form per person. • Carefully read the registration and • general Please camp print clearly. information. Complete both sides of this form. • Please print neatly. • Complete shaded area of Registrant Information (camper’s info). Please read registration and general • Please information indicate before After-Camp completing Clinics this session(s) form. near bottom of page. • Mailing and billing will be be sent to the camper’s to the child’s address. address. • No Third-party third-party billing billing. will not be done. • Please indicate sessions for your child’s registration on the right. • If camper is registered for School-Age Camps, please complete shaded area only for After-Camp Clinic registration. Use one form per child. Please complete other side > REGISTRANT INFORMATION Last Name First Name Age Address Sex (circle one) M F City State Zip T-Shirt Size (circle one) Phone Youth: (6-8) (10-12) (14-16) Adult S M L Birthdate Physician School PARENT #1 / GUARDIAN INFORMATION Last Name First Name Grade Entering (2017-18) Phone Work Phone Home Phone Cell Phone Occupation Email PARENT #2 / GUARDIAN INFORMATION Last Name First Name Work Phone Home Phone Cell Phone PAYMENT INFORMATION Are you a JCC member? JCC Membership # Payment Method Account Number Cardholder Name Expiration Date Signature Cash Check BILLING SUMMARY Total Fees Subtotal Total Enclosed Yes No Credit Card Occupation Email EMERGENCY CONTACT INFORMATION (Other than Parent) MUST BE LOCAL Name # 1 Phone #1 Phone #2 Relationship Name # 2 Phone #1 Phone #2 Relationship Please Make Your Selection(s) After-Camp Clinics ($10 Mem. /$15 Non-Mem.) Movin' & Groovin' Cardio Hoops Week 4 - 7/17 & 7/19 Week 6 - 7/31 & 8/2 Week 3 - 7/10 & 7/12 Week 5 - 7/24 & 7/26 Week 7 - 8/7 & 8/9 Boys Teen Training T/Th Noon-1 pm Girls Teen Training T/Th 3:30-4:30 pm Plyometrics Mon Noon-1 pm Wk 1 Wk 2 Wk 3 Wk 4 Wk 5 Wk 6 Wk 7 Wk 8 Please complete other side > FOR OFFICE USE ONLY Payment Received ________________ Amount ________________ Date ________________ Initials ________________ Batch # ________________ Membership Type ________________ Membership # ________________ JCC of Syracuse | 2017 Summer Camp Guide 11