2017 JCC Summer Camp Guide

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