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 Waiver 2017 After-Camp Clinics Registration JEWISH COMMUNITY CENTER - CAMP RISHON 2016 After-Camp Clinics & Teen Fitness Registration 5655 Thompson Rd., DeWitt, NY 13214 The undersigned hereby agrees to indemnify and hold harmless the Jewish Community Center, its agents, and independent contractors from and against any and all claims, damages and expenses arising out of damages, bodily injury, sickness or death resulting from use of this facility and/or participation in any activity in the Jewish Community Center Family Sports and Fitness Center. I understand that there are risks associated with participation in any exercise program, including but not limited to abrasions, musculoskeletal injuries, abnormal blood pressure, fainting, irregular heart rhythms, and in rare instances, heart attack, stroke or death. I understand that should I have any known medical condition, that it is my responsibility to consult with a physician before participating, and I acknowledge that by signing below, I am taking full responsibility for my health should I choose not to consult a practitioner. I understand that it is my responsibility to abide by all the rules of the facility. I have read the preceding paragraphs as acknowledged by my signature. Child Name __________________________________________________________ Parent/Guardian Signature _____________________________________________ Date of Birth __________________ Date _________________________ Name _______________________________________________________________ Address ______________________________________________________________ _____________________________________________________________________ City _________________________________________________________________ State ____________________________________ Zip _______________________ Home Phone _________________________________________________________ Work Phone _________________________________________________________ 12 JCC of Syracuse | 2017 Summer Camp Guide
315-445-2360 | www.jccsyr.org JEWISH COMMUNITY CENTER - CAMP RISHON 2017 Early Childhood Camps Registration Tenokia Early Childhood Camps 6 weeks - 18 month • One form per child • Please print neatly • All boxes must be completed • Please read general information before completing this form • Mailing and billing will be sent to the Camper’s address • Please indicate days and times for your child’s camp registration below. • There will be a $20 fee for any changes made after initial registration K’Ton Ton Chaverim Yeladim Gesher 18 month - 2 years old 3 year olds 4 year olds Entering Kindergarten No refunds after May 19. CAMPER Last Name First Name Age (yr. mo. ) Address Birthdate City State Zip Phone E-mail Physician PARENT #1 / GUARDIAN INFORMATION Last Name First Cell: Phone/Employer PARENT #2 / GUARDIAN INFORMATION Phone E-mail: Last Name First Cell: Phone /Employer E-Mail: EMERGENCY CONTACT INFORMATION (Other than parent) MUST BE LOCAL Name Day Phone Relationship Name Day Phone Relationship PAYMENT INFORMATION Are you a JCC member? Yes No JCC Membership # Payment Method Account Number Cardholder Name Cash Check Credit Card BILLING SUMMARY Total Camp Fees Total Weeks 1–4 Total Weeks 5–8 Registration Fee $20 Deposit $35/week Total Amount Due Now Week 1 June 26 - June 30 M-F M/W/F T/TH 9-1 7:00-1 9-3:45 7:00-6 Week 2 July 3 - July 7 (not 7/4) M-F M/W/F T/TH 9-1 7:00-1 9-3:45 7:00-6 Week 3 July 10 - July 14 M-F M/W/F T/TH 9-1 7:00-1 9-3:45 7:00-6 Week 4 July 17 - July 21 M-F M/W/F T/TH 9-1 7:00-1 9-3:45 7:00-6 Week 5 July 24 - July 28 M-F M/W/F T/TH 9-1 7:00-1 9-3:45 7:00-6 Week 6 July 31 - August 4 M-F M/W/F T/TH 9-1 7:00-1 9-3:45 7:00-6 Week 7 August 7 - August 11 M-F M/W/F T/TH 9-1 7:00-1 9-3:45 7:00-6 Week 8 August 14 - August 18 M-F M/W/F T/TH 9-1 7:00-1 9-3:45 7:00-6 Expiration Date Signature V-Code: Total Amount Enclosed Balance due on 6/15/17 Balance due on 7/15/17 T-Shirt Size (Circle) 6m 12m 18m 2T 3T 4T Youth Small Youth Medium FOR OFFICE USE ONLY Payment Received ____________ Amount ____________ Date ____________ Initials ____________ Class List _________________ Tracking _________________ Trinexum __________________________ JCC of Syracuse | 2017 Summer Camp Guide 13