CAMP YOUNG JUDAEA -- APPLICATION FOR ADMISSION

Amount of campers I wish to enroll: *

1

2

3

Camper 1

A tuition deposit of $1,000 must accompany this application.

Select Duration *

FULL SEASON: Wednesday June 29 to Thursday August 18, 2016 (Full summer, seven weeks) $7400 plus $500 camp fee ($7900)

FIRST SESSION: Wednesday June 29 to Sunday July 24, 2016 $4300 plus $250 camp fee ($4550)

SECOND SESSION: Monday July 25 to Thursday August 18, 2016 $4300 plus $250 camp fee ($4550)

TWO WEEK SESSION: Monday July 25 to August 7, 2016 $2375 plus $125 camp fee ($2500)

Camper Gender *

Male

Female

Camper First Name *

Camper Last Name *

Nickname/Please call me: *

*

	Month	Day	Year
Date of Birth	Month	Day	Year

CURRENT School Grade *

Current School *

Camper Shirt Size *

Would you like to be a waiter? *

Yes

No

Has applicant been a camper at CYJ before? *

Yes

No

If the camper is returning, what years has he or she attended CYJ?

Last Year's Bunk #

Has applicant attended any other overnight camps? *

yes

no

Camp Name

What Years?

If yes, why is camper not returning to previous camp attended?

Are there any family, behavioral, social, academic, religious, medical or special circumstances that we need to be aware of to ensure your child has a positive summer experience? Please note that this information is strictly confidential and will be treated with care. *

yes

no

If yes, please provide us with further info here or feel free to call us or email us.

Please upload a recent photo of your child. A school photo is ideal; we want a close up of your child's face. Please do not use a full-length photo or a photo with anyone else in it.

Attach a photograph of this child (max size is 5 MB)

CAMPER 1: BUNKMATE AND BED REQUEST

We request that our child share cabin with: (one name per line) Please note that we only guarantee the first name listed. If the request changes before May 1, please email us to let us know. After May 1 we cannot make changes in bunkmate requests.

+-

MY CHILD PREFERS: *

Upper bed

Lower bed

No preference

Camper 2

A tuition deposit of $1,000 must accompany this application: Please see page three for payment info

Select Duration *

FULL SEASON: Wednesday June 29 to Thursday August 18, 2016 (Full summer, seven weeks) $7400 plus $500 camp fee ($7900)

FIRST SESSION: Wednesday June 29 to Sunday July 24, 2016 $4300 plus $250 camp fee ($4550)

SECOND SESSION: Monday July 25 to Thursday August 18, 2016 $4300 plus $250 camp fee ($4550)

TWO WEEK SESSION: Monday July 25 to August 7, 2016 $2375 plus $125 camp fee ($2500)

Camper Gender *

Male

Female

Camper First Name *

Camper Last Name *

Nickname (If Any)/Please call me: *

*

	Month	Day	Year
Date of Birth	Month	Day	Year

CURRENT School Grade *

Current School *

Camper Shirt Size *

Would you like to be a waiter *

Yes

No

Has applicant been a camper at CYJ before? *

Yes

No

What Years?

Last Year's Bunk #

Has applicant attended any other overnight camps? *

yes

no

Camp Name

What Years?

If yes, why is camper not returning to previous camp attended?

Are there any family, behavioral, social, academic, religious, medical or special circumstances that we need to be aware of to ensure your child has a positive summer experience? Please note that this information is strictly confidential and will be treated with care. *

yes

no

If yes, please provide us with further info here or feel free to call us or email us.

Please upload a recent photo of your child. A school photo is ideal; we want a close up of your child's face. Please do not send a full-length photo or a photo with anyone else in it.

Attach a photograph of this child

CAMPER 2: BUNKMATE AND BED REQUEST

We request that our child share cabin with (one name per line) Please note that we only guarantee the first name listed. If the request changes before May 1, please email us to let us know. After May 1 we cannot make changes in bunkmate requests.

+-

MY CHILD PREFERS: *

Upper bed

Lower bed

No preference

Camper 3

A tuition deposit of $1,000 must accompany this application: Please see page three for payment info

Select Duration *

FULL SEASON: Wednesday June 29 to Thursday August 18, 2016 (Full summer, seven weeks) $7400 plus $500 camp fee ($7900)

FIRST SESSION: Wednesday June 29 to Sunday July 24, 2016 $4300 plus $250 camp fee ($4550)

SECOND SESSION: Monday July 25 to Thursday August 18, 2016 $4300 plus $250 camp fee ($4550)

TWO WEEK SESSION: Monday July 25 to August 7, 2016 $2375 plus $125 camp fee ($2500)

Camper Gender *

Male

Female

Camper First Name *

Camper Last Name *

Nickname (If Any)/Please call me: *

*

	Month	Day	Year
Date of Birth	Month	Day	Year

CURRENT School Grade *

Current School *

Camper Shirt Size *

Would you like to be a waiter *

Yes

No

Has applicant been a camper at CYJ before? *

Yes

No

What Years?

Last Year's Bunk #

Has applicant attended any other overnight camps? *

yes

no

Camp Name

What Years?

If yes, why is camper not returning to previous camp attended?

Are there any family, behavioral, social, academic, religious, medical or special circumstances that we need to be aware of to ensure your child has a positive summer experience? Please note that this information is strictly confidential and will be treated with care. *

yes

no

If yes, please provide us with further info here or feel free to call us or email us.

Please upload a recent photo of your child. A school photo is ideal; we want a close up of your child's face. Please do not send a full-length photo or a photo with anyone else in it.

Attach a photograph of this child

CAMPER 3: BUNKMATE AND BED REQUEST

We request that our child share cabin with (one name per line) Please note that we only guarantee the first name listed. If the request changes before May 1, please email us to let us know. After May 1 we cannot make changes in bunkmate requests.

+-

MY CHILD PREFERS: *

Upper bed

Lower bed

No preference

HOUSEHOLD INFORMATION

With whom do the campers reside? *

If only one residence--Household 1 or Household 2--please describe

If parents don’t live together, to what address should we send camp information? *

Household 1

Household 2

Both

Other. Enter name/address Other. Enter name/address

If parents don’t live together, to what address should we send invoices? *

Household 1

Household 2

Both

Other. Enter name/address Other. Enter name/address

If parents don’t live together, are they divorced? *

Yes

No

PRIMARY SUMMER CONTACT INFORMATION (Regardless of the number of households or parents' marital situation, you must indicate who the PRIMARY SUMMER CONTACT will be. This is the first person we will contact regarding camper updates, questions, or if necessary, in case of an emergency.

Primary Summer Contact Name *

Primary Summer Contact Phone *

Primary Summer Contact Second Phone

HOUSEHOLD 1 INFORMATION

Parent(s) or Guardian(s) 1 first and last name(s) *

Parent(s) or Guardian(s) 2 first and last name(s) *

How should mail be addressed to your home? (ex. Dr, Mr., Mrs., etc)? *

Street Address *

Address Line 2

City *

State *

Zip Code *

Home Phone

Cell Phone For Parent One

Cell Phone for Parent Two

Cell phone of other adult in household (if applicable)

Relationship to camper

Email Address for Parent 1 *

Email Address for Parent 2

HOUSEHOLD 2 INFORMATION (Only fill out this information if parents/guardians do not reside together)

Please use N/A if second household information is required but not applicable.

Parent(s) or Guardian(s) first and last name(s) *

Street Address *

Address Line 2

City *

State *

Zip Code *

Parent Two Home Phone *

Cell Phone for Parent Two

Cell phone of other adult in household (if applicable)

Relationship to camper

Email Address for Parent 2 *

OTHER INFORMATION

Names of any other family members currently attending CYJ

Names of any relatives who attended CYJ in the past

Is your family currently affiliated with a temple, havurah or other group? *

No

Yes

Name of temple, havurah or other group. *

New Families Only: How did you hear about CYJ? Check all that apply:

If you were referred by a family or friend, please list their name here. Please provide one name only.

PARENT’S OR GUARDIAN’S AGREEMENT

Please read carefully, sign below and make a copy of all forms for your records
We cannot register campers without the full non-refundable deposit, unless prior arrangements have been made with the directors. There are no tuition deductions or refunds for campers who come late, leave early, leave for any time period due to medical or other reasons, or are asked to leave or are dismissed from CYJ for disciplinary or other reasons. The directors reserve the right to send home any camper whose influence or actions are considered harmful or who will not follow camp rules or policies. We reserve the right to send home any camper who arrives at camp with pre-existing injuries, medical or mental health issues which have not been documented prior to arrival or if these conditions adversely affect regular camp operations, other campers or staff.

All campers must have proof of up-to-date immunizations, unless a valid health reason prohibits it. Campers will be unable to attend without them.

Balance of the camp tuition and camp fee MUST be paid no later than April 1, 2016. Unless the account is paid by April 1, the reservation can be cancelled and money refunded minus a registration and office fee of $1,000. On all cancellations, there will be a $1,000 mandatory charge. Changing from full season to one session after December 1 will result in a $500 additional fee. Enrollments received after April 1, 2016 must be accompanied by full payment.

*The camp fee of $250 per session is required to cover laundry, trips, insurance and yearbook. When parents or other designated guardians arrive to pick up at the end of the session, they must first pay the child’s canteen bill, which will include canteen purchases, special trips, prescription medication (if necessary), and other charges. We only accept cash or a personal check; payment must be made before leaving camp. If campers leave by plane or bus, payment is due no later than 10 days after departure.

Included in the camp fee is mandatory camper accident medical coverage insurance, with a maximum coverage of $2,500 per accident. Please note that our medical coverage DOES NOT COVER any medical condition which existed prior to admittance to camp or sickness/illness and dental problems occurring at camp. Bills for medical expenses (sickness/illness, dental or orthodontia) while enrolled at camp will be directly forwarded to the child’s parents for prompt payment by you or your insurance carrier. All campers must provide proof of personal health and accident insurance, including up-to-date vaccinations; we MUST have a copy of your medical insurance card no later than June 1, 2016. A health examination form must be completed by a licensed physician or nurse practitioner as per requirements of the State of New Hampshire. The form must be submitted to us prior to the opening of camp.

Visiting Day (for season campers only) will be held on Sunday July 24, 2016, beginning at 12 noon. Season campers MUST be back in camp no later than 4 p.m. that day. Alternate visiting time is available for divorced parents only. If the child’s parents are unable to come on Visiting Day, parents must choose a friend or relative who will visit; if these visitors plan to take the child out of camp we must have written permission from the parents. No other visits to campers are allowed during camp.

By signing this form, you agree to all of the above and give permission for pictures taken of your child at camp or on trips to be used in promotional or marketing literature, articles, Web sites or videos associated with the camp or camping industry. You also certify that as parent or legal guardian of the camper, the camper has your permission to participate in all Camp Young Judaea activities this summer without limitation, unless otherwise specified by a physician.

Prospective parents often ask for names, phone numbers or emails of two or three current camp families, either those who live nearby or who are similar in age/grade. In addition, current families ask us for phone numbers, addresses and emails for parents in order to send Bar and Bat Mitzvah invitations.

Please check the box below if you do NOT want us to share your parent email or address information with select families.

Do not share my information with other families.

I understand and agree that this document may be maintained in electronic form only.

Signed: *

Date: *

CYJ 2016 PAYMENT INFORMATION

If the deposit is being made by more than 1 person, please call us for details on how to proceed.

FULL SEASON: Wednesday June 29, 2016 to Thursday August 18, 2016
FIRST SESSION: Wednesday June 29, 2016 to Sunday July 24, 2016
SECOND SESSION: Monday July 25, 2016 to Thursday August 18, 2016

TWO WEEK SESSION: Monday July 25, 2016 to Sunday August 7, 2016

Session	Deposit	Tuition	Camp Fee	Total
Full Season	$1000	$7400	$500	$7900
First Session	$1000	$4300	$250	$4550
Second Session	$1000	$4300	$250	$4550

Two Week Session $1000 $2375 $125 $2500

Method of Payment: ($1,000 deposit required for each camper enrolled) *

Check (mailing details appear on next page)

Credit Card (enter credit card info on next page)

What is the first and last name of the person on the credit card that is being used to pay for the camp deposit? *

What is the relationship between the credit card account holder and the camper? *

Total Amount of Deposit (Please note: limit of $1000 per camper can be charged on a Credit Card.) *

FIRST-TIME CAMP FAMILIES OR NEW SIBLINGS OF CURRENT CAMPERS:

I am planning to apply for the Foundation for Jewish Camping’s incentive grant ($1000 for full summer or 3.5-week session or $700 for the two-week program (Please check www.onehappycamper.org to register and see if you live in an area that qualifies!!)

I am planning to apply to another program for a grant or scholarship (please specify) I am planning to apply to another program for a grant or scholarship (please specify)