2017 JCC Summer Camp Guide
The JCC of Syracuse's Summer Camp offers programs for infants, preschoolers, school-age children and teens. Camp runs June 26 - August 18, 2017.
The JCC of Syracuse's Summer Camp offers programs for infants, preschoolers, school-age children and teens. Camp runs June 26 - August 18, 2017.
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315-445-2360 | www.jccsyr.org<br />
<strong>2017</strong> After-<strong>Camp</strong> Clinics<br />
JEWISH COMMUNITY CENTER - CAMP RISHON Registration<br />
2016 After-<strong>Camp</strong> Clinics & Teen Fitness Registration<br />
5655 Thompson Rd., DeWitt, NY 13214<br />
One form per person.<br />
• Carefully read the registration and<br />
•<br />
general<br />
Please<br />
camp<br />
print clearly.<br />
information.<br />
Complete both sides of this form.<br />
• Please print neatly.<br />
• Complete shaded area of Registrant<br />
Information (camper’s info).<br />
Please read registration and general<br />
• Please information indicate before After-<strong>Camp</strong> completing Clinics this<br />
session(s) form. near bottom of page.<br />
• Mailing and billing will be be sent to the<br />
camper’s to the child’s address. address.<br />
• No Third-party third-party billing billing. will not be done.<br />
• Please indicate sessions for your child’s<br />
registration on the right.<br />
• If camper is registered for School-Age<br />
<strong>Camp</strong>s, please complete shaded area<br />
only for After-<strong>Camp</strong> Clinic registration.<br />
Use one form per child.<br />
Please complete other side ><br />
REGISTRANT INFORMATION<br />
Last Name First Name Age<br />
Address Sex (circle one) M F<br />
City State Zip<br />
T-Shirt Size (circle one)<br />
Phone<br />
Youth: (6-8) (10-12) (14-16) Adult S M L<br />
Birthdate<br />
Physician<br />
School<br />
PARENT #1 / GUARDIAN INFORMATION<br />
Last Name<br />
First Name<br />
Grade Entering<br />
(<strong>2017</strong>-18)<br />
Phone<br />
Work Phone Home Phone Cell Phone<br />
Occupation<br />
Email<br />
PARENT #2 / GUARDIAN INFORMATION<br />
Last Name<br />
First Name<br />
Work Phone Home Phone Cell Phone<br />
PAYMENT INFORMATION<br />
Are you a <strong>JCC</strong> member?<br />
<strong>JCC</strong> Membership #<br />
Payment<br />
Method<br />
Account<br />
Number<br />
Cardholder<br />
Name<br />
Expiration<br />
Date<br />
Signature<br />
Cash<br />
Check<br />
BILLING SUMMARY<br />
Total Fees<br />
Subtotal<br />
Total<br />
Enclosed<br />
Yes<br />
No<br />
Credit Card<br />
Occupation<br />
Email<br />
EMERGENCY CONTACT INFORMATION (Other than Parent) MUST BE LOCAL<br />
Name # 1 Phone #1 Phone #2 Relationship<br />
Name # 2 Phone #1 Phone #2 Relationship<br />
Please Make Your Selection(s)<br />
After-<strong>Camp</strong> Clinics ($10 Mem. /$15 Non-Mem.)<br />
Movin' &<br />
Groovin'<br />
Cardio Hoops<br />
Week 4 - 7/17 & 7/19<br />
Week 6 - 7/31 & 8/2<br />
Week 3 - 7/10 & 7/12<br />
Week 5 - 7/24 & 7/26<br />
Week 7 - 8/7 & 8/9<br />
Boys Teen Training<br />
T/Th Noon-1 pm<br />
Girls Teen Training<br />
T/Th 3:30-4:30 pm<br />
Plyometrics<br />
Mon Noon-1 pm<br />
Wk 1 Wk 2 Wk 3 Wk 4 Wk 5 Wk 6 Wk 7 Wk 8<br />
Please complete other side ><br />
FOR<br />
OFFICE<br />
USE ONLY<br />
Payment Received ________________ Amount ________________ Date ________________ Initials ________________<br />
Batch # ________________ Membership Type ________________ Membership # ________________<br />
<strong>JCC</strong> of Syracuse | <strong>2017</strong> <strong>Summer</strong> <strong>Camp</strong> <strong>Guide</strong> 11