Camp On-The-Go 2027 Application Form

Camp On-The-Go Registration Form 2027

This form is for Campers and JC's
Camper Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
Home Phone Number
Format: (000) 000-0000.
Father's Cell Phone Number
Format: (000) 000-0000.
Mother's Cell Phone Number
Format: (000) 000-0000.
Email for confirmation and information
Optional Secondary Email
Birth Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Age During Camp
Current Grade
Current School
Current Rebbe
Rebbe Phone
Emergency Contact (Not a Parent)

First NameLast Name
Emergency Contact Relationship
Emergency Contact Phone Number
Format: (000) 000-0000.
Pediatrician Name
Pediatrician Number
Please enter a valid phone number.Format: (000) 000-0000.
List Any Allergies
Provide any information on medical conditions, psychological conditions, behavioral conditions, medications, dietary restrictions, or special needs that we need to be aware of to ensure that your son's camp experience is positive.
Please Read and Check Box

I understand that there will be no refunds or reductions for days missed or for early departure from camp. I hereby authorize Camp to administer First Aid or to take my son to a doctor or hospital for any treatment which Camp deems necessary if a parent can not be reached. I accept responsibility for any medical charges which may be incurred on my son's behalf. I give my child permission to take part in all Camp activities and trips. I agree to be financially responsible for any damages or expenses caused by my son. I give Camp permission to use any photographs or media in which my son appears. It is understood and agreed that if the camper's conduct or influence is not up to the camp's standards, the camper will be dismissed at the discretion of Camp with no refund or reduction in fee. By checking this box, I hereby indicate that I have read, understood, and agree to all of these terms.
Please indicate what size t-shirt your son wears
Camp Session/s Camper is Registering for:
If registering for the weekly option only, indicate which week/s:
Deposit Payment - $200 for a whole session/$50 per week - Application not accepted until full deposit has been received

Credit Card Payment - Please check the appropriate boxes

Donate and help another child have a great summer

Any amount is greatly appreciated and will go directly towards a scholarship for a child. All donations are Tax Deductible and processed through Camp Scholarship Fund Ein #99-2963919

Free Donation Amount

Pre-Camp Week Deposit: June 21 - June 25

$50

First Session Deposit: June 24 - July 17

$200

Second Session Deposit: July 20 - August 14

$200

Post-Camp Week Deposit August 17 - August 21

$50

Weekly Option Deposit

Do NOT check this box if registering for a FULL SESSION or for the extra Week

$50 How many weeks
Item subtotal:

Extra Camp T-Shirt

$14 How many extra shirts

Total

Credit Card

Any additional questions or comments, please let us know
* Deposit is applied towards camp fee

* Full camp fee will be due by June 1

* Camp fee includes supplies, trips and everything else
Should be Empty:

Camp On-The-Go Registration Form 2027

Credit Card Payment - Please check the appropriate boxes

Credit Card