For office use only: Med____ Dep ____ P. Man_____ Chug _____ Group _____ Marks____ Mem_____ A# _______
2008 SJCC Camp Chaverim Application
(Use one form per child: applications accepted beginning March 3)
Child’s Name: (Last) _________________________________ (First) _______________________ Home Phone ________________
Age _____ Sex _____ 2008 entering grade _______ Date of birth ______________ JCC member (yes or no) ___________
Child’s Address: _______________________________________ City: __________________ State: _______ Zip ________
Camper lives with: q Both Parents OR q Mother q Father q Other _________________
Parent’s name: __________________________________________________ Home Phone: __________________________
Parent’s business address: _________________________________________ Work Phone: __________________________
Parent’s name: ___________________________________________________ Home Phone: __________________________
Parent’s business address: __________________________________________ Work Phone: ___________________________
Parent’s emergency phone # (cell phones, beepers, etc)
Name: ________________________________ # ________________________________
Name: ________________________________ # ________________________________
E-Mail: ________________________________________________________
T-shirt size, please circle: Child Sm (6-8) Child Med (10-12) Child Lg (14-16) or Adult Sm Adult Med Adult Lg
I would like to purchase an additional T-shirt for $5.00 q Yes q No
Please check the session(s) that your child will attend (see below for Travel Camp Galgalim) **No camp on July 4th.
8 week session ($200 deposit) OR 2 week sessions ($60 deposit per session)
q June 30 – August 22 q 1. June 30 – July 11 q 3. July 28 – August 8
q 2. July 14 – July 25 q 4. August 11– August 22
q Single Week registration. Please specify dates ($60 deposit per week): __________________________________________ ____________________________________________________________________________________________________
Please check the camp unit & hours you are registering for:
q Kitanim (3 - 4 year olds) q M – F q M, W, F q TU & TH q Half day (pick up at 12:30) q Full day (pick up at 4:00)
q Bonim (entering Kindergarten or 1st grade) q Half day (pick up at 12:30) q Full day (pick up at 4:00)
q Yeladim (entering 2nd or 3rd grade) q Half day (pick up at 12:30) q Full day (pick up at 4:00)
q Tzofim (entering 4th, 5th, & 6th grade) q Half day (pick up at 12:30) q Full day (pick up at 4:00)
q CIT (entering 9th grade) ($100 deposit)
q Travel Camp Galgalim: (for entering 6th, 7th and 8th grade) ($300 deposit for all 8 weeks OR $60 deposit for each week)
q 1. June 30 – July 3 **No camp on July 4th.
q 2. July 7 - July 11
q 3. July 14 – July 18
q 4. July 21 – July 25
q 5. July 28 – August 1
q 6. August 4 – August 8
q 7. August 11 – August 15
q 8. August 18 – August 22
Extended Care for Camp Chaverim OR Travel Camp Galgalim: q a.m. (7:00 – 9:00 a.m.) AND/OR q p.m. (4:00 – 6:00 p.m.)
Post Camps: August 25 - 29 ($60 deposit for all Post Camps)
q Major League Soccer Camp (entering 1st – 7th grade)
q Drama Camp (entering 2nd - 7th grade)
q JCC Science Camp (entering 1st – 6th grade)
q Art Camp (entering 2nd – 7th grade)
Extended Care for Post Camp: q a.m. (7:00 – 9:00 a.m.) AND/OR q p.m. (4:00 – 6:00 p.m.)
Child’s level of swimming if known (Red Cross swim levels 1-6) _______
In case of an emergency in which I cannot be reached, I request that the SJCC obtain emergency medical treatment for my child:
Parent or guardian signature
Hospital preference: ______________________________________________________________________________________________
Allergies to food or medication: _____________________________________________________________________________________
Medical issues/medications taken during camp hours: ___________________________________________________________________
Insurance Provider: ______________________________________ Policy #: _____________________________________________
Please circle:
My child has / does not have my permission to participate in field trips.
My child has /does not have my permission to have topical medications applied.
I do / I do not give Camp Chaverim/ Schenectady J.C.C. permission to use my child’s picture in publicity, newspapers, etc.
Emergency phone numbers (Other than the parents):
Name: _________________________________________ Relationship: _________________________ Phone: _____________
Name: _________________________________________ Relationship: ________________________ Phone: _____________
Is there any one child your child would like to be grouped with? We will try our best to honor requests: ____________________________
Does he/she have a favorite interest: ____________________________________________________________________________
Does he/she have a particular fear:______________________________________________________________________________
Please describe any social concerns (death, divorce, separation, etc): ___________________________________________________
In order to give your child the best camp experience it is important to know any special needs of your child (IEP, Speech Therapy, etc.) Please give us any information which would be helpful in caring for your child: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
If your child is new to Camp Chaverim, what did your child do in previous summers: __________________________________________
What are the primary reasons you are sending your child to Camp Chaverim: _______________________________________________
Are you able to host a Shaliach from Israel in your home: ____________________________________________________
Are you able to host a soccer coach for 1 week at your home: __________________________________
In order for your child to be registered for camp, a non-refundable deposit, per camper, must be enclosed with each application. (Please see above.) The deposit is non-refundable and non-transferable from one session to another. All fees must be paid prior to your child’s first day at camp unless other arrangements have been made with the JCC Membership Director.
I have read and understand the policies of SJCC Camp Chaverim, and hereby wish to enroll my child.
________________________________________________ ______________________________
Parent’s Signature Date