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Summer Camp Registration 2023
Please verify reCaptcha before submitting the form.
Ages:
6 months to Entering First Grade
Hours:
9:00 a.m. to 3:00 p.m.
$200 per week.
Camper Information:
*
Last Name:
*
First Name
*
Birth Date
*
Grade Level:
Weeks Attending:
Week 1: June 5
Week 2: June 12
Week 3: June 19
Week 4: June 26
Week 5: July 3
Week 6: July 10
Week 7: July 17
Week 8: July 24
Week 9: July 31
Parent Information
*
Mother's Name
*
Mother's Cell Number:
*
Mother' Email:
*
Father's Name:
*
Father's Cell Number:
Father's Email:
Emergency Information
*
In case of emergency, call:
*
Phone:
Doctor:
Preferred Hospital:
Agree
Agree
In case of emergency and neither parent can be reached, I give my permission for Congregation Rodfei Sholom to take my child to his/her doctor or call EMS so that any emergency procedures deemed necessary can be rendered. I do not hold Congregation Rodfei Sholom or its Camp Counselors responsible for any mishap that may occur to my child.
*
Signature:
*
Date:
Other important information about your child(ren) we may need to know to help them have a wonderful camp experience:
Total Registration Amount
Please review the total registration amount before clicking Submit. A separate registration form needs to be completed for each camper.
On the next few screens payment information will be collected. Please complete all steps to submit the form. If you do not complete all steps on the next pages your registration will not be captured. An instant email confirmation is sent when complete so please reach out if you do not receive one.
For more information, assistance, or to request a paper registration application, please give us a call at (210) 493-3558 or email us at
rodfeisa@gmail.com
.
Wed, September 27 2023 12 Tishrei 5784