The JCC of Syracuse's Joe & Lynne Romano summer day camp offers programs for infants, preschoolers, school-age children and teens. Camp runs June 25 - August 17, 2018.
315-445-2360 | www.jccsyr.org JEWISH COMMUNITY CENTER - CAMP RISHON 2018 School-Age 2015 School-Age and Teen Camp and Registration Teen Camp Registration 5655 Thompson Rd., DeWitt, NY 13214 • One form per child. • Mailing and billing will be sent • Carefully Please print read neatly. the registration and • No to the third-party Camper’s billing. address. general camp information. Third-party billing will not be done. • Complete both sides of this form. • Many camps have grade and equipment • Please print neatly. • requirements. *Many camps have Please grade check and program • Please read registration and general • Mailing equipment requirements. Please check information and billing before will completing be sent to this the descriptions before completing camper’s program descriptions prior to completing form. address. registration. registration. JCC Membership • There will be a $20 fee for any changes Are made you a JCC after member? initial registration. Yes No JCC Membership # Use one form per child. Bus No Transportation refunds after Request May 18. 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 (2018-19) 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 son/daughter has my permission to go on field trips during the time camp is in session. I understand that I will be informed of the exact date, time and My son/daughter has my permission to go on field trips during the time camp is in session. I understand that I will be informed of the destination exact date, of time, each trip in advance of departure. Field trips may be weather permitting. I give permission for my child to go on trips with persons designated by and destination of each trip in advance of departure. Field trips may be weather permitting. I give permission for my the child JCC to Camp go on Directors. trips with persons designated by the JCC Camp Director. My son/daughter has my permission to participate in JCC overnights. Participation is not mandatory and signature does not guarantee participation. Overnights will My take son/daughter place weeks has 2, 4, my 6, and permission 8 of camp. to Children participate must be in enrolled JCC overnights. in camp the Participation week of an overnight is not mandatory in order participate. and signature Additional does charges not guarantee apply. I participation. give permission Overnights for photographs will of take my place son/daughter weeks to 2, be 4, used 6, and in any 8 of camp. publicity Children or promotion. must be enrolled in camp the week of an overnight in order to participate. Additional charges apply. ___________________________________________________ ____________________________________________________ ____________________ 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 Date 10 JCC of Syracuse | 2018 Summer Camp Guide
315-445-2360 | www.jccsyr.org JEWISH COMMUNITY CENTER - CAMP ROMANO 2018 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 18. 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 Member # 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 $25 Deposit $50/week Total Amount Due Now Week 1 June 25 - June 29 M-F M/W/F T/TH 9-1 7:00-1 9-3:45 7:00-6 Week 2 July 2 - July 6 (not 7/4) M-F M/W/F T/TH 9-1 7:00-1 9-3:45 7:00-6 Week 3 July 9 - July 13 M-F M/W/F T/TH 9-1 7:00-1 9-3:45 7:00-6 Week 4 July 16 - July 20 M-F M/W/F T/TH 9-1 7:00-1 9-3:45 7:00-6 Week 5 July 23 - July 27 M-F M/W/F T/TH 9-1 7:00-1 9-3:45 7:00-6 Week 6 July 30 - August 3 M-F M/W/F T/TH 9-1 7:00-1 9-3:45 7:00-6 Week 7 August 6 - August 10 M-F M/W/F T/TH 9-1 7:00-1 9-3:45 7:00-6 Week 8 August 13 - August 17 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 6/15/18 Balance due on 7/15/18 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 | 2018 Summer Camp Guide 11